MEDICARE: RAVI BHUSHAN KUKKALLI P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	5501010604	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65-0-F3-1405-0	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1174727903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI BHUSHAN KUKKALLI P.T.

Provider Business Mailing Address
First Line	:	4020 VENOY RD STE 700
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-1891
Country	:	US
Telephone Number	:	734-727-1309
Fax Number	:	734-727-1319

Provider Business Practice Location Address
First Line	:	4020 VENOY RD STE 700
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-1891
Country	:	US
Telephone Number	:	734-727-1309
Fax Number	:	734-727-1319

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	10/15/2024

Similar Medicare Providers

1639024714 — JEET VIJAY PATEL
Practice Location Address:

4020 VENOY RD STE 400
WAYNE, MI
48184-1891

Practice Phone: 734-519-5200
Practice Fax:

1831176189 — DR. SHAZIA RAZA MD
Practice Location Address:

4020 VENOY RD STE 700
WAYNE, MI
48184-1891

Practice Phone: 734-454-8001
Practice Fax:

1275678948 — DR. VIJAY C PATEL M.D.
Practice Location Address:

4020 VENOY RD STE 400
WAYNE, MI
48184-1891

Practice Phone: 734-519-5200
Practice Fax: 734-519-5201

1649472960 — PREFERRED REHAB CARE INC
Practice Location Address:

4020 VENOY RD STE 700
WAYNE, MI
48184-1891

Practice Phone: 734-727-1309
Practice Fax: 734-727-1319

1942467378 — JOHN W. ARMSTEAD M.D. PC
Practice Location Address:

4020 VENOY RD. , SUITE 400
WAYNE, MI
48184-1891

Practice Phone: 734-326-5000
Practice Fax: 734-326-0102

1891640207 — CASSIE NICOLE HUTSON
Practice Location Address:

35425 W MICHIGAN AVE
WAYNE, MI
48184-9800

Practice Phone: 734-467-7600
Practice Fax:

Directions to “ RAVI BHUSHAN KUKKALLI P.T.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.