Provider Demographics
NPI:1336652965
Name:KIRAN KINRA MD PLLC
Entity Type:Organization
Organization Name:KIRAN KINRA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-659-2233
Mailing Address - Street 1:1375 FLUSHING RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-2262
Mailing Address - Country:US
Mailing Address - Phone:810-659-2233
Mailing Address - Fax:810-659-2246
Practice Address - Street 1:540 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-1474
Practice Address - Country:US
Practice Address - Phone:810-659-2233
Practice Address - Fax:810-659-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty