Individual
DR. CHILAKAPATI VIJAYA KUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14752 NORTHLINE RD, SOUTHGATE, MI 48195-2467
(734) 285-5030
(734) 285-8223
Mailing address
PO BOX 77000 DEPT 771255, DETROIT, MI 48277-4085
(313) 271-3000
(313) 271-3003
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
4301040566
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101651
GREAT LAKES HEALTH PLAN
MI
01
—
107216
CARE CHOICES
MI
01
—
110Q26434
BCBS
MI
01
—
204980
FEDERAL BLACK LUNG
MI
05
—
2801430
—
MI
01
—
4629716
AETNA
MI
Enumeration date
08/10/2005
Last updated
01/30/2019
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