Provider Demographics
NPI:1518914712
Name:KENKRE, CHAYA (MD)
Entity Type:Individual
Prefix:
First Name:CHAYA
Middle Name:
Last Name:KENKRE
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:PO BOX 130146
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48113-0146
Mailing Address - Country:US
Mailing Address - Phone:734-761-8439
Mailing Address - Fax:734-761-8439
Practice Address - Street 1:5301 E. HURON RIVER DR.
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48106
Practice Address - Country:US
Practice Address - Phone:734-712-4108
Practice Address - Fax:734-712-4129
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII04762Medicare UPIN