Provider Demographics
NPI:1538281647
Name:KAKARALA, MADHURI (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MADHURI
Middle Name:
Last Name:KAKARALA
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2144 E PARIS AVE SE STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6126
Mailing Address - Country:US
Mailing Address - Phone:616-685-2100
Mailing Address - Fax:616-685-2111
Practice Address - Street 1:2144 E PARIS AVE SE STE 200
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6126
Practice Address - Country:US
Practice Address - Phone:616-685-2100
Practice Address - Fax:616-685-2111
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077687207R00000X, 207RX0202X, 390200000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1538281647Medicaid
MIP01094225OtherRR MEDICARE
MIP01094225OtherRR MEDICARE