Individual
PRASANTHI MADDALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 745-7233
(313) 993-3889
Mailing address
349 MERRIWEATHER RD, GROSSE POINTE FARMS, MI 48236-3430
(305) 934-8922
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
326734-01
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/03/2019
Last updated
10/16/2024
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