Provider Demographics
NPI:1427519354
Name:GHANDIKOTA, KIRTANA SAI RATNA (MD)
Entity type:Individual
Prefix:
First Name:KIRTANA
Middle Name:SAI RATNA
Last Name:GHANDIKOTA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR.
Mailing Address - Street 2:LOBBY J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6466
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR. IHA LIVINGSTON PEDIATRICS
Practice Address - Street 2:SUITE 240
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114
Practice Address - Country:US
Practice Address - Phone:810-494-6820
Practice Address - Fax:810-229-0747
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-08-09
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301507429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics