Provider Demographics
NPI:1396053351
Name:KUKREJA, GEETIKA (MD)
Entity type:Individual
Prefix:
First Name:GEETIKA
Middle Name:
Last Name:KUKREJA
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 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1528
Mailing Address - Fax:
Practice Address - Street 1:3140 W CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2776
Practice Address - Country:US
Practice Address - Phone:989-667-2370
Practice Address - Fax:989-671-9275
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096737207RH0003X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396053351Medicaid