Provider Demographics
NPI:1164455895
Name:JITENDRA P KATNENI MD PC
Entity Type:Organization
Organization Name:JITENDRA P KATNENI MD PC
Other - Org Name:INTERNAL MEDICINE ASSOCIATES OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JITENDRA
Authorized Official - Middle Name:P
Authorized Official - Last Name:KATNENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-5000
Mailing Address - Street 1:5155 NORKO DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3021
Mailing Address - Country:US
Mailing Address - Phone:810-230-7532
Mailing Address - Fax:810-230-7764
Practice Address - Street 1:1170 CHARTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3587
Practice Address - Country:US
Practice Address - Phone:810-733-5000
Practice Address - Fax:810-733-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051876207R00000X, 207RG0300X
MI4301063797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty