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Organization
SAILAJA DATLA MD PLC
Active
Organization
SAILAJA DATLA MD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAILAJA DATLA MD (OWNER)
(586) 445-3706
Entity
Organization
Contact information
Practice address
21519 HARPER AVE STE 108, SAINT CLAIR SHORES, MI 48080-2220
(586) 445-3706
Mailing address
21519 HARPER AVE STE 108, SAINT CLAIR SHORES, MI 48080-2220
(586) 445-3706
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
SD070545
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1105010262
BCBS
—
05
—
4354525
—
MI
Enumeration date
09/29/2009
Last updated
09/29/2009
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