Healthcare Provider Details

I. General information

NPI: 1548231749
Provider Name (Legal Business Name): AMBUJAM R KRISHNAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15645 FARMINGTON RD
LIVONIA MI
48154-2851
US

IV. Provider business mailing address

15645 FARMINGTON RD
LIVONIA MI
48154-2851
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-7600
  • Fax: 734-464-9797
Mailing address:
  • Phone: 734-464-7600
  • Fax: 734-464-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberAK043104
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: