1639268709 NPI number — DR. GANESH RAMASWAMI MD

Table of content: DR. GANESH RAMASWAMI MD (NPI 1639268709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639268709 NPI number — DR. GANESH RAMASWAMI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAMASWAMI
Provider First Name:
GANESH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639268709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12701 TELEGRAPH RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
TAYLOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48180-6847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-287-1950
Provider Business Mailing Address Fax Number:
734-287-1954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12701 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180-6847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-287-1950
Provider Business Practice Location Address Fax Number:
734-287-1954
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  4301086629 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4763811 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020G361410 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4301086629 . This is a "LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1001254 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 150753 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com