Provider Demographics
NPI:1205008877
Name:METRO DETROIT KIDNEY DOCTORS, P.C.
Entity Type:Organization
Organization Name:METRO DETROIT KIDNEY DOCTORS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAYNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGRECHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-417-3876
Mailing Address - Street 1:27550 SCHOENHERR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4798
Mailing Address - Country:US
Mailing Address - Phone:586-776-4200
Mailing Address - Fax:586-933-2353
Practice Address - Street 1:27550 SCHOENHERR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4798
Practice Address - Country:US
Practice Address - Phone:586-776-4200
Practice Address - Fax:586-933-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110E024840OtherBCBSM GROUP NUMBER