Provider Demographics
NPI:1700977154
Name:TATINENI, KAMESWARA R (MD)
Entity type:Individual
Prefix:MR
First Name:KAMESWARA
Middle Name:R
Last Name:TATINENI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:126 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3461
Mailing Address - Country:US
Mailing Address - Phone:268-968-4140
Mailing Address - Fax:269-968-3113
Practice Address - Street 1:126 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3461
Practice Address - Country:US
Practice Address - Phone:268-968-4140
Practice Address - Fax:269-968-3113
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010408092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2111671Medicaid
MI2111671Medicaid