Healthcare Provider Details

I. General information

NPI: 1619947819
Provider Name (Legal Business Name): SAI LAKSHMI KANNEGANTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SCHAEFER RD
DEARBORN MI
48126-3249
US

IV. Provider business mailing address

37610 DORCHESTER DR
FARMINGTON HILLS MI
48331-1860
US

V. Phone/Fax

Practice location:
  • Phone: 313-581-2600
  • Fax: 313-581-0228
Mailing address:
  • Phone: 810-788-1276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301052238
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: