Healthcare Provider Details

I. General information

NPI: 1184632176
Provider Name (Legal Business Name): SREEKANT S NAIR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BOB SREEDHARAN NAIR

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31505 THIRTY TWO MILE ROAD
RICHMOND MI
48062
US

IV. Provider business mailing address

PO BOX 250 31505 THIRTY TWO MILE ROAD
RICHMOND MI
48062
US

V. Phone/Fax

Practice location:
  • Phone: 586-727-2761
  • Fax: 586-727-3120
Mailing address:
  • Phone: 586-727-2761
  • Fax: 586-727-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014675
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: