Provider Demographics
NPI:1013987437
Name:KAKARALA, RADHIKA R (MD)
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:R
Last Name:KAKARALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:G3499 S. LINDEN ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-720-3930
Practice Address - Fax:810-720-3970
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059166207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102545112OtherBLUE CROSS BLUE SHIELD
MI1003585OtherMCLAREN HEALTH PLAN
MI3187558Medicaid
MIF66034OtherHEALTH NET FEDERAL SERVIC
MI1003585OtherHEALTH ADVANTAGE NETWORK
MI4171919Medicaid
MIOM28450003Medicare ID - Type Unspecified
MI1102545112OtherBLUE CROSS BLUE SHIELD