Provider Demographics
NPI:1104056290
Name:KAMBALI, SHRINIVAS (MD)
Entity type:Individual
Prefix:
First Name:SHRINIVAS
Middle Name:
Last Name:KAMBALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1015 S WASHINGTON AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2556
Mailing Address - Country:US
Mailing Address - Phone:989-907-7636
Mailing Address - Fax:989-907-7584
Practice Address - Street 1:1015 S WASHINGTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2556
Practice Address - Country:US
Practice Address - Phone:989-907-7636
Practice Address - Fax:989-907-7584
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301092283207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine