Healthcare Provider Details

I. General information

NPI: 1174088066
Provider Name (Legal Business Name): KB CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4563 WASHTENAW AVE STE B
ANN ARBOR MI
48108-1011
US

IV. Provider business mailing address

2232 S MAIN ST # 447
ANN ARBOR MI
48103-6938
US

V. Phone/Fax

Practice location:
  • Phone: 734-263-1141
  • Fax: 734-263-1142
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHIDAMBER B. ALAMELUMAMGAPURAM
Title or Position: MD
Credential: MD
Phone: 734-972-1610