Provider Demographics
NPI:1518035062
Name:MOVVA, KALYANI T (MD)
Entity Type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:T
Last Name:MOVVA
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 1:901 MCCLINTOCK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0871
Mailing Address - Country:US
Mailing Address - Phone:888-220-6432
Mailing Address - Fax:630-734-4715
Practice Address - Street 1:15474 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48170-4893
Practice Address - Country:US
Practice Address - Phone:248-615-0889
Practice Address - Fax:734-404-5317
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI174400000X
MI4301074529207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KM074529OtherCOMMERCIAL-COMMERCIAL NUMBER
KM074529OtherCHAMPUS-CHAMPUS
MI462085510Medicaid
700H262220OtherBLUE CROSS-BLUE CROSS
KM074529OtherCHAMPUS-CHAMPUS
I12823Medicare UPIN