| Kavitha Ponduri Md Pc | |
|
34659 W Michigan Ave Wayne MI 48184-1730 | |
| (734) 722-2400 | |
| (734) 722-1709 |
| Full Name | Kavitha Ponduri Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 34659 W Michigan Ave, Wayne, Michigan |
| Authorized Official Name and Position | Kavitha Ponduri (PRESIDENT) |
| Authorized Official Contact | 7347222400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kavitha Ponduri Md Pc 34659 W Michigan Ave Wayne MI 48184-1730 Ph: (734) 722-2400 | Kavitha Ponduri Md Pc 34659 W Michigan Ave Wayne MI 48184-1730 Ph: (734) 722-2400 |
| NPI Number | 1336344431 |
|---|---|
| Provider Enumeration Date | 06/19/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 5395845143 |
|---|---|
| Medicare Enrollment ID | O20070710000513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336344431 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kavitha Ponduri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679568315 PECOS PAC ID: 0941300792 Enrollment ID: I20070710000509 |
| Provider Name | Sasi Boppana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528053196 PECOS PAC ID: 6901906759 Enrollment ID: I20070710000535 |
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