# KAVITHA PONDURI MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336344431
- **Authorized official:** DR. KAVITHA PONDURI M.D. (PRESIDENT)
- **Authorized official phone:** (734) 722-2400

## Contact information

- **Practice address:** 34659 W MICHIGAN AVE, WAYNE, MI 48184-1730
- **Practice address phone:** (734) 722-2400
- **Practice address fax:** (734) 722-1709
- **Mailing address:** 34659 W MICHIGAN AVE, WAYNE, MI 48184-1730
- **Mailing address phone:** (734) 722-2400
- **Mailing address fax:** (734) 722-1709

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/19/2007
- **Last updated:** 08/22/2020