| Organization Name: | OKEMOS PRIMARY CARE PHYSICIANS PC |
| NPI Number: | 1104079268 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUDHA R YENUMULA (PRESIDENT AND CEO) |
| Mailing Address: | 2104 Jolly Rd Suite 290 Okemos |
| State: | MI US |
| Postal Code: | 488646038 |
| Phone Number: | 5177087283 |
| Fax Number: | 5177087294 |
| NPI Enumeration Date: | 11/02/2008 |
| NPI Last Update Date: | 05/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 4301087786 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |