Individual
CHAKRAVARTHY KANDURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, 2825 LIVERNOIS, TROY, MI 48083
(248) 528-2310
(248) 528-8112
Mailing address
HENRY FORD HEALTH SYSTEM, 2825 LIVERNOIS, TROY, MI 48083
(248) 528-2310
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
071718
MI
207RG0100X
Gastroenterology Physician
Primary
071718
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100H264400
BLUE CROSS-BLUE CROSS
—
05
—
426710710
—
MI
01
—
CK071718
CHAMPUS-CHAMPUS
—
Enumeration date
12/06/2006
Last updated
08/17/2012
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