Provider Demographics
NPI:1679520167
Name:USHA R TAMPI MD PC
Entity type:Organization
Organization Name:USHA R TAMPI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:USHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAMPI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-243-4220
Mailing Address - Street 1:730 NORTH MACOMB STREET
Mailing Address - Street 2:SUITE 229
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2904
Mailing Address - Country:US
Mailing Address - Phone:734-243-4220
Mailing Address - Fax:734-457-3131
Practice Address - Street 1:730 NORTH MACOMB STREET
Practice Address - Street 2:SUITE 229
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2904
Practice Address - Country:US
Practice Address - Phone:734-243-4220
Practice Address - Fax:734-457-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI039683207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDG6056OtherPALMETTO GBA
UT039683OtherBLUE CROSS & BLUE SHIELD
MI184284010Medicaid
MI184284010Medicaid
0P50350Medicare PIN