Provider Demographics
NPI:1457352676
Name:KUMAR, CHILAKAPATI VIJAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHILAKAPATI
Middle Name:VIJAYA
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHILAKAPATI
Other - Middle Name:VIJAYA
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 77000 DEPT 771255
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-4085
Mailing Address - Country:US
Mailing Address - Phone:313-271-3000
Mailing Address - Fax:313-271-3003
Practice Address - Street 1:14752 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2467
Practice Address - Country:US
Practice Address - Phone:734-285-5030
Practice Address - Fax:734-285-8223
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040566207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2801430Medicaid
MI101651OtherGREAT LAKES HEALTH PLAN
MI107216OtherCARE CHOICES
MI204980OtherFEDERAL BLACK LUNG
MI110Q26434OtherBCBS
MI4629716OtherAETNA
MI2801430Medicaid
A75967Medicare UPIN
MI101651OtherGREAT LAKES HEALTH PLAN
MIC2789OtherM-CARE
MI0Q26434Medicare ID - Type Unspecified