Individual
ANURAG KHANDAVALLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
36500 S GRATIOT AVE, CLINTON TOWNSHIP, MI 48035-1772
(586) 790-9003
(586) 493-3603
Mailing address
36500 S GRATIOT AVE, CLINTON TOWNSHIP, MI 48035-1772
(586) 790-9003
(586) 493-3603
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5151015492
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2022
Last updated
06/27/2022
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