Provider Demographics
NPI:1285869982
Name:POTHUGUNTA, KRISHNA (MD)
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:POTHUGUNTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 INVESTMENT DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6365
Mailing Address - Country:US
Mailing Address - Phone:248-267-5010
Mailing Address - Fax:
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:SUITE 290
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-267-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093847207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology