Provider Demographics
NPI:1194764878
Name:SARVEPALLI, SAILAJA (MD)
Entity type:Individual
Prefix:
First Name:SAILAJA
Middle Name:
Last Name:SARVEPALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48829-8740
Mailing Address - Country:US
Mailing Address - Phone:989-427-5320
Mailing Address - Fax:989-427-8220
Practice Address - Street 1:1021 E. MAIN STREET
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-9737
Practice Address - Country:US
Practice Address - Phone:989-427-5320
Practice Address - Fax:989-427-8220
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1007287OtherMCLAREN
MI20000002628OtherPHYSICIANS HEALTH PLAN
MI0805900382OtherBCBSM
MI0983228OtherHEALTHPLUS COMMERCIAL
MI1006841OtherMCLAREN HEALTH PLAN
200000005869OtherPHP COMMERCIAL
MIG55917Medicare UPIN
MI1007287OtherMCLAREN