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General NPI Number Information
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NPI Number | 1427223346
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Entity Type | Individual
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Provider Name | CHENNI S SRIRAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 3901 BEAUBIEN - 4TH FL CHILDRENS HOSPITAL OF MI
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 313-745-5484
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Fax | 313-966-2423
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Provider Business Mailing Address
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Address Line | 4201 ST. ANTOINE - UHC 5D MAILBOX 226 UNIVERSITY PEDIATRICIANS
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City | DETROIT
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State | MI
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Zip | 48201-2153
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Country | US
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Telephone | 313-745-4405
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Fax | 313-966-0665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD449353
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 57012940
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 104900
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 53481
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 57012940
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License Number State | MI
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