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General NPI Number Information
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NPI Number | 1881768075
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Entity Type | Individual
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Provider Name | MADHAVI KANNEGANTI MD
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 11670 MARTIN
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-754-3830
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Fax | 586-754-3840
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Provider Business Mailing Address
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Address Line | 11670 MARTIN
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City | WARREN
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State | MI
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Zip | 48093
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Country | US
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Telephone | 586-754-3830
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Fax | 586-754-3840
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MK058470
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MK058470
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License Number State | MI
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