Healthcare Provider Details

I. General information

NPI: 1679387997
Provider Name (Legal Business Name): ANIRUDH K VENBAKKAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 RESEARCH PARK DR # B-1A
ANN ARBOR MI
48108-2229
US

IV. Provider business mailing address

24667 THATCHER DRIVE
NOVI MI
48375
US

V. Phone/Fax

Practice location:
  • Phone: 734-794-2930
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: