Healthcare Provider Details

I. General information

NPI: 1447640792
Provider Name (Legal Business Name): SANJEEV VENKATARAMAN, MD, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 ANDOVER RD STE 220
BLOOMFIELD HILLS MI
48302-1909
US

IV. Provider business mailing address

4111 ANDOVER RD STE 220
BLOOMFIELD HILLS MI
48302-1909
US

V. Phone/Fax

Practice location:
  • Phone: 248-290-5400
  • Fax: 248-290-5401
Mailing address:
  • Phone: 248-290-5400
  • Fax: 248-290-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberSV056477
License Number StateMI

VIII. Authorized Official

Name: SANJEEV VENKATARAMAN
Title or Position: DOCTOR
Credential: MD
Phone: 248-290-5400