Provider Demographics
NPI:1144282799
Name:CHAKRAVARTHY, NALINI (MD)
Entity type:Individual
Prefix:DR
First Name:NALINI
Middle Name:
Last Name:CHAKRAVARTHY
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:DEPT 77913
Mailing Address - Street 2:PO BOX 77000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48272-0001
Mailing Address - Country:US
Mailing Address - Phone:734-459-7444
Mailing Address - Fax:734-459-7755
Practice Address - Street 1:37595 7 MILE RD
Practice Address - Street 2:SUITE 420
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1003
Practice Address - Country:US
Practice Address - Phone:734-459-7444
Practice Address - Fax:734-459-7755
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINC075540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300163180OtherTAX ID
MI4534292Medicaid