Individual
DR. JYOTHI NUTAKKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8435 HOLLY RD, GRAND BLANC, MI 48439-1812
(810) 424-2400
(810) 579-7222
Mailing address
3495 S CENTER RD, BURTON, MI 48519-1455
(810) 424-2007
(810) 743-1099
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
4301069608
MI
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
4301069608
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4518708
—
MI
Enumeration date
08/31/2006
Last updated
09/20/2007
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