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NPI Code Detail

MEDICARE: GOURI RAMESH M.D.

MEDICARE: GOURI RAMESH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080A0000XPediatric Adolescent Medicine Physician4301064864MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1GR064864OTHERMIBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1982634119
Entity Type Code : Individual
Provider Name (Legal Business Name) : GOURI RAMESH M.D.
Provider Business Mailing Address
First Line : 7900 KERCHEVAL ST
Second Line :
City : DETROIT
State : MI
Zip : 48214-2439
Country : US
Telephone Number : 313-921-5500
Fax Number : 313-921-5530
Provider Business Practice Location Address
First Line : 7900 KERCHEVAL ST
Second Line :
City : DETROIT
State : MI
Zip : 48214-2439
Country : US
Telephone Number : 313-921-5500
Fax Number : 313-921-5530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 01/29/2018

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