Provider Demographics
NPI:1821151598
Name:LUTHRA, KAVITA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITA
Middle Name:
Last Name:LUTHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 E MICHIGAN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2490
Mailing Address - Country:US
Mailing Address - Phone:517-788-7866
Mailing Address - Fax:517-796-9339
Practice Address - Street 1:900 E MICHIGAN AVE STE 104
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2490
Practice Address - Country:US
Practice Address - Phone:517-788-7866
Practice Address - Fax:517-796-9339
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301069837207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH 73958Medicare UPIN
P07720001Medicare ID - Type Unspecified