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Individual

VIJAY KUMAR GORINTALA SUBBANNA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1000 HOUGHTON AVE, SAGINAW, MI 48602-5303
(989) 583-6800
(989) 583-6915
Mailing address
1000 HOUGHTON AVE, SAGINAW, MI 48602-5303
(989) 583-6800
(989) 583-6915

Taxonomy

Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
4301089563
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
105203187
MI
01
4301089563
LICENSE
MI
Enumeration date
04/17/2007
Last updated
09/12/2007
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