| Sailaja Datla Md Plc | |
|
21519 Harper Ave Ste 108 Saint Clair Shores MI 48080-2220 | |
| (586) 445-3706 | |
| Not Available |
| Full Name | Sailaja Datla Md Plc |
|---|---|
| Speciality | Internal Medicine |
| Location | 21519 Harper Ave Ste 108, Saint Clair Shores, Michigan |
| Authorized Official Name and Position | Sailaja Datla (OWNER) |
| Authorized Official Contact | 5864453706 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sailaja Datla Md Plc 21519 Harper Ave Ste 108 Saint Clair Shores MI 48080-2220 Ph: (586) 445-3706 | Sailaja Datla Md Plc 21519 Harper Ave Ste 108 Saint Clair Shores MI 48080-2220 Ph: (586) 445-3706 |
| NPI Number | 1881928455 |
|---|---|
| Provider Enumeration Date | 09/29/2009 |
| Last Update Date | 09/29/2009 |
| Medicare PECOS PAC ID | 7618013665 |
|---|---|
| Medicare Enrollment ID | O20091006000393 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881928455 | NPI | - | NPPES |
| 1105010262 | Other | BCBS | |
| 4354525 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | SD070545 (Michigan) | Primary |
| Provider Name | Sailaja Datla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154434975 PECOS PAC ID: 4981740933 Enrollment ID: I20091006000387 |
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