Basic Information
| Provider Information | |||||||||
| NPI: | 1134104540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KESARI | ||||||||
| FirstName: | KAVITHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | G 3499 S. LINDEN RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107203930 | ||||||||
| FaxNumber: | 8107203970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301067874 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1102504512 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 110B56125 | 01 | MI | BLUE CARE NETWORK | OTHER | 5998721 | 01 | MI | AETNA | OTHER | G98882 | 01 | MI | HAP | OTHER | G98882 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 110B56125 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 1994534001 | 01 | MI | CIGNA | OTHER | 110B56125 | 01 | MI | BLUE CHOICE | OTHER | 4116980 | 05 | MI | MEDICAID | 4116980 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 4116980 | 01 | MI | HEALTH ADVANTAGE NETWORK | OTHER | C7503 | 01 | MI | MCARE | OTHER | 0985486 | 01 | MI | HEALTHPLUS | OTHER | 110B56125 | 01 | MI | COMMUNITY BLUE PPO | OTHER |