Individual
MR. HARGOPAL TEKUMULLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1702 WATER ST, PORT HURON, MI 48060-4136
(810) 966-9102
(810) 966-9104
Mailing address
1702 WATER ST, PORT HURON, MI 48060-4136
(810) 966-9102
(810) 966-9104
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501008202
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0G41113
BLUE CARE NETWORK, MICHIGAN
MI
01
—
164232
GREAT LAKES HEALTH PLAN
MI
01
—
48102
HEALTH PLAN OF MICHIGAN
MI
05
—
4863011
—
MI
01
—
650G411130
BCBS OF MICHIGAN
MI
Enumeration date
10/25/2006
Last updated
11/04/2008
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