Individual
CHINNA ALEXIS GANGADHARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2689
(248) 885-2536
Mailing address
423 TILBURY RD, BLOOMFIELD HILLS, MI 48301-2742
(248) 885-2536
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704399287
MI
Other
Enumeration date
03/30/2026
Last updated
03/30/2026
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