Basic Information
| Provider Information | |||||||||
| NPI: | 1326661687 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KAVITA | ||||||||
| FirstName: | FNU | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | C/O SHELLY CASEY, ST. JOSEPH MERCY OAKLAND HOSPITAL | ||||||||
| Address2: | 44405 WOODWARD AVENUE MEDICAL EDUCATION - H23 | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488583000 | ||||||||
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| Practice Location | |||||||||
| Address1: | C/O SHELLY CASEY, ST. JOSEPH MERCY OAKLAND HOSPITAL | ||||||||
| Address2: | 44405 WOODWARD AVENUE MEDICAL EDUCATION - H23 | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488583000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2020 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.