Individual
DR. KEMPAIAH A GOWDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15150 FORT ST, SOUTHGATE, MI 48195-1302
(734) 282-4800
(734) 282-9302
Mailing address
15150 FORT ST, SOUTHGATE, MI 48195-1302
(734) 282-4800
(734) 282-9302
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
4301037652
MI
207RC0000X
Cardiovascular Disease Physician
Primary
4301037654
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0608201051
BLUE CROSS BLUE SHIELD
MI
01
—
0820105
BLUE CARE NETWORK
MI
01
—
110007760
RR MEDICARE
MI
01
—
11277306
CAQH
MI
05
—
1623343
—
MI
01
—
1730133265
BCBS TYPE 1 NPI #
MI
01
—
4301037652
STATE LICENSE #
MI
01
—
B43075
HAP
MI
Enumeration date
05/20/2006
Last updated
03/30/2017
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