NPIMap

Organization Active NPI

Latha T Kannan, MD, PC

  • Infectious Disease Physician
  • Bloomfield Hills, MI
National Provider Identifier
1619170644
Registry record updated Dec 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
LK070401 Issued in MI
Legal business name
LATHA T KANNAN, MD, PC
Practice address
6715 Birmingham Club Drive
Bloomfield Hills, MI 48301
Phone
(248) 353-4777
Fax
(248) 353-4235
NPI assigned
Jun 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2010

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

Authorized official

Name
Dr. Latha T Kannan, M.D.NPI 1528015427
Title
Owner
Phone
(248) 353-4777

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X LK070401 MI Primary

Addresses

Primary practice location

6715 Birmingham Club Drive
Bloomfield Hills, MI 48301

Mailing address

6715 Birmingham Club Drive
Bloomfield, MI 48301
Phone (248) 353-4777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040525001210 MI Part B Supplier - Clinic/Group Practice 7214918473 Receives reassigned benefits from 7 practitioners
Practice locations: Detroit, MI

National Provider Directory

National Provider Directory

Locations

22972 Lahser Rd
Southfield, MI 48033
Phone (248) 225-2072

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1619170644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6715 BIRMINGHAM CLUB DRIVE",
            "city": "BLOOMFIELD",
            "state": "MI",
            "postal_code": "48301",
            "telephone_number": "248-353-4777",
            "fax_number": "248-353-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6715 BIRMINGHAM CLUB DRIVE",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "48301",
            "telephone_number": "248-353-4777",
            "fax_number": "248-353-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LATHA T KANNAN, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-07",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "KANNAN",
        "authorized_official_first_name": "LATHA",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-353-4777",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "MI",
            "license": "LK070401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.