Organization
GREAT LAKES INTERVENTIONAL PAIN MANAGEMENT,PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAVITHA RUKKANNAGARI REDDY M.D. (PHYSICIAN)
(810) 410-5148
Entity
Organization
Contact information
Practice address
1311 S LINDEN RD, SUITE A, FLINT, MI 48532-3428
(810) 230-1210
(810) 230-1225
Mailing address
1311 S LINDEN RD, SUITE A, FLINT, MI 48532-3428
(810) 230-1210
(810) 230-1225
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
4301085040
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174515084
NPI
MI
05
—
5353030
—
MI
Enumeration date
09/18/2015
Last updated
11/17/2016
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