Individual
DR. VISALA DANDAMUDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
25869 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4997
(586) 773-6020
(586) 773-6093
Mailing address
25869 KELLY RD, SUITE A, ROSEVILLE, MI 48066-4997
(586) 773-6020
(586) 773-6093
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301080937
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4658039
—
MI
Enumeration date
06/29/2006
Last updated
04/01/2008
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