Individual
HIMAJA GUMMADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
30901 PALMER RD, WESTLAND, MI 48186-9529
(734) 367-8403
(734) 722-9524
Mailing address
172 QUEEN ANNE DR, CANTON, MI 48187-4682
(734) 397-1805
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301070128
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508883299
WRPH
MI
01
—
2600052028
RAILROAD
MI
01
—
260Q26259
BCBSM GR#
MI
05
—
4867342
—
MI
01
—
HG070108
LICENSE
MI
Enumeration date
07/15/2006
Last updated
07/09/2007
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