Provider Demographics
NPI:1861667222
Name:RAVINDRANATH KAMBHAMPATI, M.D., P.C.
Entity Type:Organization
Organization Name:RAVINDRANATH KAMBHAMPATI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDRANATH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBHAMPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-852-9411
Mailing Address - Street 1:2820 CROOKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3620
Mailing Address - Country:US
Mailing Address - Phone:248-852-9411
Mailing Address - Fax:248-852-4279
Practice Address - Street 1:2820 CROOKS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3620
Practice Address - Country:US
Practice Address - Phone:248-852-9411
Practice Address - Fax:248-852-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037362208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0637586OtherBLUE CARE NETWORK
MI136004500OtherOWCP
MI4331587OtherAETNA
MI2406375861OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4331587OtherAETNA
MIA76543Medicare UPIN