Provider Demographics
NPI:1033115944
Name:KINRA, KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:KINRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 FLUSHING RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2262
Mailing Address - Country:US
Mailing Address - Phone:810-659-2233
Mailing Address - Fax:810-659-2246
Practice Address - Street 1:1375 FLUSHING RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433
Practice Address - Country:US
Practice Address - Phone:810-659-2233
Practice Address - Fax:810-659-2246
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKK042002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1347705Medicaid
4414745OtherAETNA
010021744OtherPALMETTO GBA
MI1102500432OtherBLUE CROSS
A77574Medicare UPIN
A77574Medicare UPIN
MI1347705Medicaid
MI1102500432OtherBLUE CROSS