Healthcare Provider Details

I. General information

NPI: 1174649354
Provider Name (Legal Business Name): KIDNEY AND HYPERTENSION SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE STE 104
JACKSON MI
49201-2457
US

IV. Provider business mailing address

900 E MICHIGAN AVE STE 104
JACKSON MI
49201-2457
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-7866
  • Fax: 517-796-9339
Mailing address:
  • Phone: 517-788-7866
  • Fax: 517-796-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRN042337
License Number StateMI

VIII. Authorized Official

Name: DR. REDDIVALEM VENKATA NAGESH
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 517-788-7866