Individual
KALLANAGOUDA NANDIHALLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
711 S HEALTH PKWY, SUITE 4, THREE RIVERS, MI 49093-9387
(269) 273-8557
(269) 279-6461
Mailing address
701 S HEALTH PKWY, MEDICAL STAFF OFFICE, THREE RIVERS, MI 49093-8352
(269) 273-9789
(269) 273-9611
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301040630
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1107500091
BCBS PIN
MI
05
—
3146760 10
—
MI
05
—
4258500 10
—
MI
05
—
4459984 10
—
MI
05
—
4459993 10
—
MI
05
—
4892292 10
—
MI
01
—
700G560080
BCBS GROUP
MI
Enumeration date
11/16/2005
Last updated
07/18/2011
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