Organization
KIDNEY CENTER OF MICHIGAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMITH KAKULAVARAM M.D. (PRESIDENT)
(248) 858-3011
Entity
Organization
Contact information
Practice address
44555 WOODWARD AVE, SUITE 404, PONTIAC, MI 48341-5031
(248) 858-3011
(800) 414-1646
Mailing address
PO BOX 71026, ROCHESTER HILLS, MI 48307-0019
(248) 858-3011
(800) 414-1646
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4301084121
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301084121
LICENSE
MI
Enumeration date
12/14/2011
Last updated
02/24/2012
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