Individual
VAMSHIDHAR GUDUGUNTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25195 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4909
(586) 775-4594
(586) 775-4506
Mailing address
25195 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4909
(586) 775-4594
(586) 775-4506
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301063528
MI
207RI0011X
Interventional Cardiology Physician
4301063528
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060-501-2281
BLUE CROSS BLUE SHIELD
MI
05
—
4472707
—
MI
01
—
OH-26467013
MEDICARE ID
MI
Enumeration date
08/12/2005
Last updated
03/07/2023
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