Individual
BALASUBRAMANIYAM PISUPATI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
3235 E MICHIGAN AVE, JACKSON, MI 49202-3971
(517) 990-1242
Mailing address
3235 E MICHIGAN AVE, JACKSON, MI 49202-3971
(517) 990-1242
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
5501007541
MI
Other
Enumeration date
10/20/2006
Last updated
02/26/2008
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