Provider Demographics
NPI:1235719816
Name:CHENNAIAH GARI, NIKHITA REDDY (MD)
Entity type:Individual
Prefix:
First Name:NIKHITA
Middle Name:REDDY
Last Name:CHENNAIAH GARI
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 1:19251 MACK AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2891
Mailing Address - Country:US
Mailing Address - Phone:313-343-3823
Mailing Address - Fax:313-343-7840
Practice Address - Street 1:19251 MACK AVE STE 340
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2891
Practice Address - Country:US
Practice Address - Phone:313-343-3823
Practice Address - Fax:313-343-7840
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351052109390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program