Individual
MOHAN KRISHNA BANGARU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4201 SAINT ANTOINE ST, DETROIT, MI 48201-2153
(313) 745-7145
Mailing address
19426 MAYFIELD AVE APT 104, LIVONIA, MI 48152-4203
(313) 421-6686
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4301119098
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B526609478425
DRIVING LICENSE
MI
Enumeration date
08/16/2014
Last updated
07/21/2022
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