Individual
DR. LAKSHMI SUBBA NELLUTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7733 E JEFFERSON AVE, DETROIT, MI 48214-3707
(313) 499-4900
(313) 499-4483
Mailing address
17197 N LAUREL PARK DR, SUITE 161, LIVONIA, MI 48152-2680
(734) 338-8300
(734) 338-8301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301093294
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700H231390
BCBS GROUP NUMBER
MI
Enumeration date
01/23/2009
Last updated
10/06/2010
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