Provider Demographics
NPI:1730292368
Name:MEKALA, SANTHI (MD)
Entity Type:Individual
Prefix:
First Name:SANTHI
Middle Name:
Last Name:MEKALA
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 1:1397 S LINDEN RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-4194
Mailing Address - Country:US
Mailing Address - Phone:810-720-9300
Mailing Address - Fax:810-720-9304
Practice Address - Street 1:1397 S LINDEN RD STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-4194
Practice Address - Country:US
Practice Address - Phone:810-720-9300
Practice Address - Fax:810-720-9304
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISM074337207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104874955Medicaid
MI1107900041OtherBLUE CROSS BLUE SHIELD
MIP00027167OtherRAILROAD MEDICARE
MI1107900041OtherBLUE CROSS BLUE SHIELD