Provider Demographics
NPI:1851468441
Name:KANNEGANTI, RAJENDRA (MD)
Entity Type:Individual
Prefix:
First Name:RAJENDRA
Middle Name:
Last Name:KANNEGANTI
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 1:2115 BIRCHWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1603
Mailing Address - Country:US
Mailing Address - Phone:248-538-8992
Mailing Address - Fax:
Practice Address - Street 1:20100 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-1803
Practice Address - Country:US
Practice Address - Phone:313-342-2699
Practice Address - Fax:313-342-2180
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010524332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry