Individual
AMITHA KAKULAVARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
44200 WOODWARD AVE STE 209, PONTIAC, MI 48341-5045
(248) 253-0330
(248) 253-1982
Mailing address
5280 METROPOLITAN PKWY, STERLING HEIGHTS, MI 48310-4005
(248) 858-3011
(800) 414-1646
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301084121
MI
207RN0300X
Nephrology Physician
Primary
4301084121
MI
208M00000X
Hospitalist Physician
4301084121
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720267800
—
MI
Enumeration date
10/25/2007
Last updated
06/06/2022
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