Kidney Center of Michigan

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

4301084121 Issued in MI

Legal business name

KIDNEY CENTER OF MICHIGAN

Practice address

44555 Woodward Ave
Suite 404
Pontiac, MI 48341-5031

Phone

(248) 858-3011

Fax

(800) 414-1646

NPI assigned

Dec 14, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amith Kakulavaram, M.D.

Title

President

Phone

(248) 858-3011

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1083983498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71026",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483070019",
            "telephone_number": "248-858-3011",
            "fax_number": "800-414-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44555 WOODWARD AVE",
            "address_2": "SUITE 404",
            "city": "PONTIAC",
            "state": "MI",
            "postal_code": "483415031",
            "telephone_number": "248-858-3011",
            "fax_number": "800-414-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CENTER OF MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "KAKULAVARAM",
        "authorized_official_first_name": "AMITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-858-3011",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301084121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "4301084121",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mahmood A Khalid, MD
• Muhammad Khan, MD
• Muhammad Roohan Khan, MD
• Garima Khanna, O.D
• Alexander M Khobeir, MD
• Kidney Centers of Michigan LLC
• Jordan Kieft
• Lord J. Kim, LMSW
• Young DO Kim, DDS
• Jessica Kimball, DO

• Nephrology Physician in Pontiac, MI
• Providers in Pontiac, MI by specialty
• Nephrology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.