Provider Demographics
NPI:1962466268
Name:KALAHASTY, SAMBAMURTY (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMBAMURTY
Middle Name:
Last Name:KALAHASTY
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 1:7445 ALLEN RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1963
Mailing Address - Country:US
Mailing Address - Phone:313-382-0505
Mailing Address - Fax:313-382-1584
Practice Address - Street 1:7445 ALLEN RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1963
Practice Address - Country:US
Practice Address - Phone:313-382-0505
Practice Address - Fax:313-382-1584
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI041891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4134414Medicaid
MISK041891OtherSTATE LICENSE
MISK041891OtherSTATE LICENSE