=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588783963
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VENKATASIVA PERAM MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 03/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2222 S LINDEN RD SUITE G
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-720-0002
-----------------------------------------------------
Fax | 810-720-0005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2222 S LINDEN RD SUITE G
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48532-5475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-720-0002
-----------------------------------------------------
Fax | 810-720-0005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. ARUNA PERAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-720-0002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | 4301070246
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------