Sailaja Datla MD PLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

SD070545 Issued in MI

Legal business name

SAILAJA DATLA MD PLC

Practice address

21519 Harper Ave Ste 108
Saint Clair Shores, MI 48080-2220

Phone

(586) 445-3706

NPI assigned

Sep 29, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sailaja Datla, MDNPI 1154434975

Title

Owner

Phone

(586) 445-3706

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sailaja Datla, MD

  • Internal Medicine Physician
  • Saint Clair Shores, MI
  • NPI 1154434975
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254182400000",
    "number": "1881928455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21519 HARPER AVE STE 108",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802220",
            "telephone_number": "586-445-3706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21519 HARPER AVE STE 108",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480802220",
            "telephone_number": "586-445-3706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAILAJA DATLA MD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-29",
        "last_updated": "2009-09-29",
        "status": "A",
        "authorized_official_last_name": "DATLA",
        "authorized_official_first_name": "SAILAJA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-445-3706",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "SD070545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1105010262",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4354525",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• David James Saglimbene, D.D.S.
• Mohammed Sahly, MD
• Saint Clair Family Pharmacy LLC
• Saint Clair Shores Pharmacy LLC
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• Monika Saladiak, LPC
• Isabella Salas, BEHAVIOR TECHNICIAN

• Internal Medicine Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.