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1063422319
THRESIAMMA IDICHANDY
DETROIT, MI
NPI
1063422319
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MI 4704171067)
Enumeration Date
2006-08-09
Last Update Date
2007-07-08
Business Address
Mrs. THRESIAMMA IDICHANDY Nurse practitioner
4646 JOHN R ST
DETROIT, MI 48201-1916
Phone number: 313-576-1000
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Mailing Address
Mrs. THRESIAMMA IDICHANDY Nurse practitioner
5085 WESTMORELAND DR
TROY, MI 48085-3443
Phone number: 248-528-8106
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