Provider Demographics
NPI:1336312867
Name:KELKAR, PREETI S (MD)
Entity Type:Individual
Prefix:
First Name:PREETI
Middle Name:S
Last Name:KELKAR
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 1:42010 BAINTREE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-2363
Mailing Address - Country:US
Mailing Address - Phone:248-348-0788
Mailing Address - Fax:
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:STE B-7
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-522-8540
Practice Address - Fax:734-522-5405
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010416522085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301041652OtherMICHIGAN LICENSE