Organization
MICHIGAN PSYCIATRIC & BEHAVIORAL ASSOCIATES PC
Active
Other names
MPBA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KISHORE KONDAPANENI MD (CEO)
(989) 922-4900
Entity
Organization
Contact information
Practice address
690 S TRUMBULL ST, BAY CITY, MI 48708-7656
(989) 922-4900
(989) 922-4911
Mailing address
690 S TRUMBULL ST, BAY CITY, MI 48708-7656
(989) 922-4900
(989) 922-4911
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260Z910350
BCBS
MI
01
—
ON34080
MEDICARE
MI
Enumeration date
01/26/2007
Last updated
03/22/2012
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