Provider Demographics
NPI:1528115037
Name:CHITTURI, RADHA KUMARI (MD)
Entity type:Individual
Prefix:
First Name:RADHA
Middle Name:KUMARI
Last Name:CHITTURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RADHA
Other - Middle Name:KUMARI
Other - Last Name:CHITTURI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11670 MARTIN
Mailing Address - Street 2:KAISER MEDICAL CENTER
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093
Mailing Address - Country:US
Mailing Address - Phone:586-754-3830
Mailing Address - Fax:586-754-3840
Practice Address - Street 1:11670 MARTIN
Practice Address - Street 2:KAISER MEDICAL
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093
Practice Address - Country:US
Practice Address - Phone:586-754-3830
Practice Address - Fax:586-754-3840
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315007189170100000X, 363A00000X
MI4301078798207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4359595Medicaid
MI4359595Medicaid
MIH57706Medicare UPIN