Organization

Kidney Center Of Michigan

Nephrology Physician in Pontiac, MI(View on Map)

Legal Business Name

Kidney Center Of Michigan

NPI Number

1083983498

NPI Type

Organization

Enumeration Date

12/14/2011

Specialties

(Taxonomies)

Code

207RN0300X

Primary Taxonomy

Yes

Licenses

State

Michigan

License Number

4301084121

Contact
Information

Purpose

Mailing
Location

Address

PO BOX 71026
44555 WOODWARD AVE

City

Rochester Hills
Pontiac

State

MI
MI

Postal Code

48307-0019
48341-5031

Country

US
US

Telephone Number

(248) 858-3011
(248) 858-3011

Authorized Official

Name

Amith Kakulavaram

Title or Position

PRESIDENT

Telephone Number

(248) 858-3011

Identifiers

Identifier

4301084121

Identifier State

MI

Identifier Issuer

LICENSE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 02/24/2012

Provider Address