Healthcare Provider Details

I. General information

NPI: 1144282799
Provider Name (Legal Business Name): NALINI CHAKRAVARTHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37595 7 MILE RD SUITE 420
LIVONIA MI
48152-1003
US

IV. Provider business mailing address

DEPT 77913 PO BOX 77000
DETROIT MI
48272-0001
US

V. Phone/Fax

Practice location:
  • Phone: 734-459-7444
  • Fax: 734-459-7755
Mailing address:
  • Phone: 734-459-7444
  • Fax: 734-459-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNC075540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: