Provider Demographics
NPI:1518297886
Name:KAKARLA-MAGANTI, AMITA
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:
Last Name:KAKARLA-MAGANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMITA
Other - Middle Name:
Other - Last Name:KAKARLA MAGANTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4246 AUTUMN RDG
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-8669
Mailing Address - Country:US
Mailing Address - Phone:989-791-2044
Mailing Address - Fax:
Practice Address - Street 1:4246 AUTUMN RDG
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-8669
Practice Address - Country:US
Practice Address - Phone:989-791-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051055207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology