Individual
DR. KANWAR VIRENDER MENDIRATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
26699 W 12 MILE RD STE 101, SOUTHFIELD, MI 48034-7814
(248) 358-0011
(248) 358-1491
Mailing address
26699 W 12 MILE RD STE 101, SOUTHFIELD, MI 48034-7814
(248) 358-0011
(248) 358-1491
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
KM041292
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111193
CARE CHOICES
—
01
—
14765
HEALTH PLAN OF MICHIGAN
—
01
—
2149224
AETNA
—
01
—
2906303621
BLUE CROSS BLUE SHIELD
—
05
—
3127120
—
MI
01
—
C1457
MCARE
—
Enumeration date
08/10/2006
Last updated
06/11/2024
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