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Organization
GREAT LAKES INTERVENTIONAL PAIN MANAGEMENT,PLLC
Active
Organization
GREAT LAKES INTERVENTIONAL PAIN MANAGEMENT,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAVITHA RUKKANNAGARI REDDY M.D. (PHYSICIAN)
(810) 410-5148
Entity
Organization
Contact information
Practice address
1311 S LINDEN RD, SUITE A, FLINT, MI 48532-3428
(810) 230-1210
(810) 230-1225
Mailing address
1311 S LINDEN RD, SUITE A, FLINT, MI 48532-3428
(810) 230-1210
(810) 230-1225
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
4301085040
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174515084
NPI
MI
05
—
5353030
—
MI
Enumeration date
09/18/2015
Last updated
11/17/2016
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