Provider Demographics
NPI:1093198467
Name:SAGINALA, KALYAN CHAKRAVARTHY (MD)
Entity type:Individual
Prefix:
First Name:KALYAN CHAKRAVARTHY
Middle Name:
Last Name:SAGINALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 TUURI PL
Mailing Address - Street 2:APT # 116
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 HURLEY PLZ
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5902
Practice Address - Country:US
Practice Address - Phone:484-340-6077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301107894390200000X
MI5315071136390200000X
NMMD2019-0286207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program