Individual
GEETHA KRISHNAMOORTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
44428 WOODWARD AVE STE 102, PONTIAC, MI 48341-5009
(248) 858-3126
(248) 858-6499
Mailing address
24 FRANK LLOYD WRIGHT DR # J2000, ANN ARBOR, MI 48105-9484
(734) 747-6766
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301062031
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110F336360
BCBSM
MI
01
—
1346398971
GROUP NPI
MI
01
—
205485614
TAX ID
MI
05
—
3347713
—
MI
01
—
4301062031
LICENSE
MI
01
—
G53324
HAP ID
MI
Enumeration date
06/03/2006
Last updated
03/26/2025
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