Provider Demographics
NPI:1134104540
Name:KESARI, KAVITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:KESARI
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 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:G 3499 S. LINDEN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-720-3930
Practice Address - Fax:810-720-3970
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301067874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102504512OtherBLUE CROSS BLUE SHIELD
MI110B56125OtherBLUE CARE NETWORK
MI5998721OtherAETNA
MIG98882OtherHAP
MIG98882OtherHEALTH NET FEDERAL SERVIC
MI110B56125OtherBLUE CROSS BLUE SHIELD
MI1994534001OtherCIGNA
MI110B56125OtherBLUE CHOICE
MI4116980Medicaid
MI4116980OtherMCLAREN HEALTH PLAN
MI4116980OtherHEALTH ADVANTAGE NETWORK
MIC7503OtherMCARE
MI0985486OtherHEALTHPLUS
MI110B56125OtherCOMMUNITY BLUE PPO
MIC7503OtherMCARE
MI4116980Medicaid