Provider Demographics
NPI:1821383779
Name:KAKARALA, JAGANMOHANARAO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAGANMOHANARAO
Middle Name:
Last Name:KAKARALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2991 OMLESAAD DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9244
Mailing Address - Country:US
Mailing Address - Phone:734-913-4078
Mailing Address - Fax:
Practice Address - Street 1:2991 OMLESAAD DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9244
Practice Address - Country:US
Practice Address - Phone:734-913-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035496207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine