Provider Demographics
NPI:1619072907
Name:KAKATI, MANJULA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MANJULA
Middle Name:
Last Name:KAKATI
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 1:200 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1250
Mailing Address - Country:US
Mailing Address - Phone:205-759-0799
Mailing Address - Fax:205-759-0845
Practice Address - Street 1:200 UNIVERSITY BLVD
Practice Address - Street 2:BRYCE HOSPITAL
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1250
Practice Address - Country:US
Practice Address - Phone:205-759-0799
Practice Address - Fax:205-759-0845
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00063551Medicare ID - Type Unspecified