Provider Demographics
NPI:1104015403
Name:SANJEEV VENKATARAMAN, M.D., P.C.
Entity Type:Organization
Organization Name:SANJEEV VENKATARAMAN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEV
Authorized Official - Middle Name:SHANMUGA
Authorized Official - Last Name:VENKATARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-737-4525
Mailing Address - Street 1:4639 RAVINE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3640
Mailing Address - Country:US
Mailing Address - Phone:248-737-4525
Mailing Address - Fax:248-290-5401
Practice Address - Street 1:4111 ANDOVER RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1909
Practice Address - Country:US
Practice Address - Phone:248-290-5400
Practice Address - Fax:248-290-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISV0564772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty