1104015403 NPI number — SANJEEV VENKATARAMAN, M.D., P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104015403 NPI number — SANJEEV VENKATARAMAN, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANJEEV VENKATARAMAN, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1104015403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4639 RAVINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48301-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-737-4525
Provider Business Mailing Address Fax Number:
248-290-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4111 ANDOVER RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
BLOOMFIELD HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48302-1909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-290-5400
Provider Business Practice Location Address Fax Number:
248-290-5401
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VENKATARAMAN
Authorized Official First Name:
SANJEEV
Authorized Official Middle Name:
SHANMUGA
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
248-737-4525

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  SV056477 , 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)





Copyright © 2007-2026 www.npivalidator.com