Provider Demographics
NPI:1538553433
Name:KORPOLE, PRANAY REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:PRANAY
Middle Name:REDDY
Last Name:KORPOLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37484 N LAUREL PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3947
Mailing Address - Country:US
Mailing Address - Phone:775-313-7654
Mailing Address - Fax:
Practice Address - Street 1:37595 7 MILE RD STE 340
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1003
Practice Address - Country:US
Practice Address - Phone:734-793-2470
Practice Address - Fax:734-793-2471
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315204924207R00000X
MI4301117436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine