Provider Demographics
NPI:1548254899
Name:NAGRECHA, NAYNA S (MD)
Entity type:Individual
Prefix:
First Name:NAYNA
Middle Name:S
Last Name:NAGRECHA
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 1:285 VINCENNES PL
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3114
Mailing Address - Country:US
Mailing Address - Phone:313-417-3876
Mailing Address - Fax:
Practice Address - Street 1:23995 GREATER MACK AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1417
Practice Address - Country:US
Practice Address - Phone:586-585-9727
Practice Address - Fax:586-933-2353
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076247207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110E024840OtherBCBS GROUP NUMBER
MI11-0502230-2OtherBCBS INDIVIDUAL PIN NUMBER
I29494Medicare UPIN
MI0P56330Medicare PIN
MI110E024840OtherBCBS GROUP NUMBER