Ravichand Madala M.D.

NPI 1083730907 - Psychiatry & Neurology - 2084N0400X

NPI Details
NPI 1083730907
Gender Male
Enumeration Date 03/22/2007
Last Updated 02/10/2014
Entity Type Individual
Active Over 10 years ago
Practice Location
4100 LAKE DR SE
SUITE 100
GRAND RAPIDS MI, 49546-8292, US
Phone (616) 391-3759
Fax (616) 391-3052
Business Location
100 MICHIGAN ST NE
MC845
GRAND RAPIDS MI, 49503-2560, US
Phone (616) 486-6557
Fax (616) 486-6702
Toxanomy
Taxonomy Code 2084N0400X
License State Ohio
License Number 35089399
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According to our database, Dr. Ravichand Madala M.D. NPI is 1083730907, taxonomy code is 2084N0400X and license number is 35089399, license state is located at Ohio. Ravichand Madala M.D. physically located at 4100 Lake Dr Se, Grand Rapids MI, 49546-8292. NPI Number Ravichand Madala M.D. has the Individual type.

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1083730907 NPI number is provided on an as is basis without warranty of any kind. 1083730907 is maintained by the National Plan & Provider Enumeration System. The contents of Ravichand Madala M.D. are for informational purposes only.