Individual
DR. MADHU MENDIRATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
26699 WEST 12 MILE RD, SUITE 100, SOUTHFIELD, MI 48034-1754
(248) 945-9370
(248) 945-9377
Mailing address
26699 WEST 12 MILE RD, SUITE 100, SOUTHFIELD, MI 48034-1754
(248) 945-9370
(248) 945-9377
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301048520
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2606309652
BC
MI
01
—
383583448
PPOM
MI
Enumeration date
09/15/2005
Last updated
05/14/2014
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