Healthcare Provider Details

I. General information

NPI: 1437731833
Provider Name (Legal Business Name): SWETHA KONDAVEETI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2021
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15560 JOY RD
DETROIT MI
48228-8200
US

IV. Provider business mailing address

3010 N SPURWAY DR
ANN ARBOR MI
48105-1497
US

V. Phone/Fax

Practice location:
  • Phone: 248-745-4900
  • Fax:
Mailing address:
  • Phone: 859-559-3979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301513408
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number4301513408
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: