Provider Demographics
NPI:1720156276
Name:ARAVAPALLY, AMITHA (MD)
Entity type:Individual
Prefix:DR
First Name:AMITHA
Middle Name:
Last Name:ARAVAPALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMITHA
Other - Middle Name:
Other - Last Name:KOPPARAM -ARAVAPALLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13801 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4206
Mailing Address - Country:US
Mailing Address - Phone:586-757-9707
Mailing Address - Fax:586-757-9808
Practice Address - Street 1:13801 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4206
Practice Address - Country:US
Practice Address - Phone:586-757-9707
Practice Address - Fax:586-757-9808
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine