Active NPI
Manjuli Kodagoda, M.D.
- Family Medicine Physician
- Southfield, MI
National Provider Identifier
1649564717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301097423
- Practice address
- 16001 W 9 Mile Rd
Southfield, MI 48075-4803 - Phone
- (248) 849-3000
- NPI assigned
- Jun 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301097423 | MI | Primary |
Addresses
Primary practice location
16001 W 9 Mile Rd
Southfield, MI 48075-4803
Mailing address
16001 W 9 Mile Road
Southfield, MI 48075-4803
Phone (248) 849-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301097423 | MI | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307318400000",
"number": "1649564717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16001 W 9 MILE ROAD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480754803",
"telephone_number": "248-849-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16001 W 9 MILE RD",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480754803",
"telephone_number": "248-849-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KODAGODA",
"first_name": "MANJULI",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-06",
"last_updated": "2011-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301097423",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.