Individual
DR. SHAILAJA GADDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202
(800) 653-6568
Mailing address
1 FORD PL STE 2E, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301084980
MI
2084N0400X
Neurology Physician
Primary
4301084980
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4754518
—
MI
Enumeration date
09/20/2005
Last updated
12/13/2018
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