Individual
JAGANNADHARAO DIVVELA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8244 METROPOLITAN PKWY, SUITE C, STERLING HEIGHTS, MI 48312-2778
(586) 795-4060
(586) 795-5596
Mailing address
8244 METROPOLITAN PKWY, SUITE C, STERLING HEIGHTS, MI 48312-2778
(586) 795-4060
(586) 795-5596
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301039338
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4587910
—
MI
Enumeration date
12/14/2005
Last updated
07/08/2007
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