Healthcare Provider Details

I. General information

NPI: 1821151598
Provider Name (Legal Business Name): KAVITA LUTHRA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE STE 104
JACKSON MI
49201-2490
US

IV. Provider business mailing address

900 E MICHIGAN AVE STE 104
JACKSON MI
49201-2490
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 Code207RN0300X
TaxonomyNephrology Physician
License Number4301069837
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: