Basic Information
| Provider Information | |||||||||
| NPI: | 1427519354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHANDIKOTA | ||||||||
| FirstName: | KIRTANA | ||||||||
| MiddleName: | SAI RATNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 FRANK LLOYD WRIGHT DR. | ||||||||
| Address2: | LOBBY J2000 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347476466 | ||||||||
| FaxNumber: | 7342223100 | ||||||||
| Practice Location | |||||||||
| Address1: | 2305 GENOA BUSINESS PARK DR. IHA LIVINGSTON PEDIATRICS | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104946820 | ||||||||
| FaxNumber: | 8102290747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2019 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301507429 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.