MEDICARE: KIRAN SOORAJ THIRUKONDA JEGADEESH BABU MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1457295776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRAN SOORAJ THIRUKONDA JEGADEESH BABU MD

Provider Business Mailing Address
First Line	:	HENRY FORD MACOMB HOSPITAL
Second Line	:	15855 19 MILE RD.,
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038
Country	:	US
Telephone Number	:	313-916-1601
Fax Number	:	313-916-2018

Provider Business Practice Location Address
First Line	:	HENRY FORD MACOMB HOSPITAL
Second Line	:	15855 19 MILE RD.,
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038
Country	:	US
Telephone Number	:	313-916-1601
Fax Number	:	313-916-2018

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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