Provider Demographics
NPI:1104081397
Name:VELUGUBANTI, GIREESH (MD)
Entity type:Individual
Prefix:DR
First Name:GIREESH
Middle Name:
Last Name:VELUGUBANTI
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:GIREESH
Other - Middle Name:
Other - Last Name:VELUGUBANTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:44648 MOUND RD STE 131
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1322
Mailing Address - Country:US
Mailing Address - Phone:419-777-8260
Mailing Address - Fax:947-282-1112
Practice Address - Street 1:21700 NORTHWESTERN HWY STE 150
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4906
Practice Address - Country:US
Practice Address - Phone:419-777-8260
Practice Address - Fax:947-282-1112
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087670208000000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1578934600OtherNPI-2 ORGANIZATION