Provider Demographics
NPI:1538392378
Name:METRO DETROIT KIDNEY ASSOCIATES
Entity type:Organization
Organization Name:METRO DETROIT KIDNEY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAYNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NAGRECHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-585-9727
Mailing Address - Street 1:1292 EDMUNDTON DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1027
Mailing Address - Country:US
Mailing Address - Phone:313-417-3876
Mailing Address - Fax:
Practice Address - Street 1:23995 GREATER MACK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1417
Practice Address - Country:US
Practice Address - Phone:586-585-9727
Practice Address - Fax:586-933-2353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076247207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7658683OtherAETNA PIN
MI11-0502230-2OtherBCBS PIN
MI151185OtherGREAT LAKES HEALTH PLAN PIN
MI151185OtherGREAT LAKES HEALTH PLAN PIN