Provider Demographics
NPI:1518916147
Name:KHAMBETE, DEVYANI S (MD)
Entity Type:Individual
Prefix:
First Name:DEVYANI
Middle Name:S
Last Name:KHAMBETE
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 1:2482 WICKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3269
Mailing Address - Country:US
Mailing Address - Phone:248-682-3300
Mailing Address - Fax:248-682-0026
Practice Address - Street 1:2561 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3313
Practice Address - Country:US
Practice Address - Phone:248-682-3300
Practice Address - Fax:248-682-0026
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI152891OtherGREAT LAKES
MI0635263OtherBCBSM
MI609494OtherHAP
MIC5278OtherHEALTH PLUS
MI114546OtherCARE CHOICES
MI997209OtherHEALTH PLUS
MI4817940Medicaid
MI4817921Medicaid