Active NPI
Lakshmi Subba Nellutla, MD
- Family Medicine Physician
- Detroit, MI
National Provider Identifier
1629216007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301093294
- Practice address
- 7733 E Jefferson Ave
Detroit, MI 48214-3707 - Phone
- (313) 499-4900
- Fax
- (313) 499-4483
- NPI assigned
- Jan 23, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301093294 | MI | Primary |
Addresses
Primary practice location
7733 E Jefferson Ave
Detroit, MI 48214-3707
Mailing address
17197 N Laurel Park Dr
Suite 161
Livonia, MI 48152-2680
Phone (734) 338-8300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700H231390 | Other | MI | BCBS GROUP NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301093294 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Services of Detroit PC | Family Medicine | Past | Accepting new patients |
| Medical Services of Detroit PC | Family Medicine | Past | Accepting new patients |
| Ozarks Medical Center | Family Medicine | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Southfield, MI
- NPI 1821177163
Family Medicine
-
- Family Medicine Physician
- Southfield, MI
- NPI 1821296815
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286323200000",
"number": "1629216007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17197 N LAUREL PARK DR",
"address_2": "SUITE 161",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481522680",
"telephone_number": "734-338-8300",
"fax_number": "734-338-8301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7733 E JEFFERSON AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482143707",
"telephone_number": "313-499-4900",
"fax_number": "313-499-4483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELLUTLA",
"first_name": "LAKSHMI",
"middle_name": "SUBBA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-23",
"last_updated": "2010-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301093294",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP NUMBER",
"identifier": "700H231390",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.