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General NPI Number Information
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NPI Number | 1124969332
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Entity Type | Individual
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Provider Name | MOUKTHIKA VAKA VENKATA NAGA
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Gender | Female
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 1521 GULL RD
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City | KALAMAZOO
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State | MI
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Zip | 49048-1640
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Country | US
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Telephone | 269-226-8374
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Fax | 269-226-8349
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Provider Business Mailing Address
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Address Line | 38260 SARATOGA CIR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3706
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Country | US
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Telephone | 269-226-8374
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Fax | 269-226-8349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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