Provider Demographics
NPI:1639400799
Name:KP ANANDAKRISHNAN MD PC
Entity Type:Organization
Organization Name:KP ANANDAKRISHNAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KP
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANDAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-326-3353
Mailing Address - Street 1:5189 VENOY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2545
Mailing Address - Country:US
Mailing Address - Phone:734-326-3353
Mailing Address - Fax:734-326-9130
Practice Address - Street 1:5189 VENOY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2545
Practice Address - Country:US
Practice Address - Phone:734-326-3353
Practice Address - Fax:734-326-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031632207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0829938OtherBCBS
MI0829938OtherBCBS
MIMI2569001Medicare PIN