Individual provider Active NPI

Kalavathy K Srinivasan, MD

  • Pediatrics Physician
  • Ann Arbor, MI
National Provider Identifier
1609836410
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301038366 Issued in MI
Practice address
1500 East Medical Center Dr
B1 Floor University Hospital Recp Emergency
Ann Arbor, MI 48109-0014
Phone
(734) 936-6666
NPI assigned
Mar 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4301038366 MI
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 4301038366 MI
Pediatrics Physician 208000000X 4301038366 MI Primary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 4301038366 MI

Addresses

Primary practice location

1500 East Medical Center Dr
B1 Floor University Hospital Recp Emergency
Ann Arbor, MI 48109-0014

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 2

IdentifierTypeStateIssuer
KS038366OtherMIBC/BS OF MI
4339618MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100331001102 MI Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 0547396269 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301038366MIMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Pediatricians Pediatrics CurrentSince Apr 22, 2001 Accepting new patients
University Pediatricians Pediatrics CurrentSince Apr 22, 2001 Accepting new patients

Locations

1 William Carls Dr
Commerce Twp, MI 48382
Phone (248) 227-5500

3901 Beaubien St
Fl 4
Detroit, MI 48201
Phone (313) 745-4878

3901 Beaubien St
Detroit, MI 48201
Phone (313) 745-5227

4201 Saint Antoine St
Detroit, MI 48201
Phone (313) 745-3615

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1143158400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1609836410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "address_2": "B1 FLOOR UNIVERSITY HOSPITAL RECP EMERGENCY",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481090014",
            "telephone_number": "734-936-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRINIVASAN",
        "first_name": "KALAVATHY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-24",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4301038366",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "4301038366",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301038366",
            "primary": true
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "MI",
            "license": "4301038366",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF MI",
            "identifier": "KS038366",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4339618",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.