1427519354 NPI number — KIRTANA SAI RATNA GHANDIKOTA MD

Table of content: KIRTANA SAI RATNA GHANDIKOTA MD (NPI 1427519354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427519354 NPI number — KIRTANA SAI RATNA GHANDIKOTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GHANDIKOTA
Provider First Name:
KIRTANA
Provider Middle Name:
SAI RATNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427519354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 FRANK LLOYD WRIGHT DR.
Provider Second Line Business Mailing Address:
LOBBY J2000
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-747-6466
Provider Business Mailing Address Fax Number:
734-222-3100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2305 GENOA BUSINESS PARK DR. IHA LIVINGSTON PEDIATRICS
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-494-6820
Provider Business Practice Location Address Fax Number:
810-229-0747
Provider Enumeration Date:
03/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  4301507429 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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