Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 5101021656 | MI |
NPI | 1043698988 |
---|---|
Provider Name | Krishna Chaitanya Meka |
First Address | Portage, MI 49024-7430 |
Second Address | Portage, MI 49024-7430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2015 |
Last Update Date | 31/08/2021 |