Individual
SARAT CHANDRA KHANDAVALLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9606
(616) 252-7166
Mailing address
PO BOX 1629, LIMA, OH 45802-1629
(877) 378-4293
(419) 223-2726
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301097445
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11295996916
—
MI
Enumeration date
06/25/2008
Last updated
07/14/2021
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