Provider Demographics
NPI:1336164003
Name:VARDE, KANAK A (MD)
Entity Type:Individual
Prefix:DR
First Name:KANAK
Middle Name:A
Last Name:VARDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 W UNIVERSITY DR
Mailing Address - Street 2:RADIOLOGY DEPT
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1863
Mailing Address - Country:US
Mailing Address - Phone:248-652-5325
Mailing Address - Fax:248-652-5159
Practice Address - Street 1:1101 W UNIVERSITY DR
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1863
Practice Address - Country:US
Practice Address - Phone:248-652-5325
Practice Address - Fax:248-652-9731
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0377522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2730230Medicaid
B48718Medicare UPIN
F36447007Medicare ID - Type Unspecified