Healthcare Provider Details

I. General information

NPI: 1295041192
Provider Name (Legal Business Name): ARCHANA KURRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 08/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E CANFIELD ST
DETROIT MI
48201-1804
US

IV. Provider business mailing address

3737 BEAUBIEN ST APT 907,INTERNATIONAL GUEST HOUSE
DETROIT MI
48201-2152
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4832
  • Fax:
Mailing address:
  • Phone: 313-405-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301096015
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: