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General NPI Number Information
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NPI Number | 1619170644
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Entity Type | Organization
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Legal Business Name | LATHA T KANNAN, MD, PC
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 12/09/2010
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Provider Practice Location Address
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Address Line | 6715 BIRMINGHAM CLUB DRIVE
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301
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Country | US
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Telephone | 248-353-4777
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Fax | 248-353-4235
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Provider Business Mailing Address
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Address Line | 6715 BIRMINGHAM CLUB DRIVE
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City | BLOOMFIELD
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State | MI
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Zip | 48301
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Country | US
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Telephone | 248-353-4777
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Fax | 248-353-4235
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Authorized Official
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Title or Position | OWNER
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Name | DR. LATHA T KANNAN
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Credential | M.D.
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Telephone | 248-353-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | LK070401
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License Number State | MI
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