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General NPI Number Information
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NPI Number | 1639400799
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Entity Type | Organization
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Legal Business Name | KP ANANDAKRISHNAN MD PC
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 10/21/2014
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Provider Practice Location Address
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Address Line | 5189 VENOY RD
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City | WAYNE
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State | MI
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Zip | 48184-2545
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Country | US
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Telephone | 734-326-3353
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Fax | 734-326-9130
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Provider Business Mailing Address
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Address Line | 5189 VENOY RD
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City | WAYNE
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State | MI
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Zip | 48184-2545
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Country | US
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Telephone | 734-326-3353
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Fax | 734-326-9130
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KP ANANDAKRISHNAN
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Credential | M.D.
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Telephone | 734-326-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 4301031632
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License Number State | MI
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