Provider Demographics
NPI:1164663852
Name:PASHAM, SWATHI R (MD)
Entity Type:Individual
Prefix:
First Name:SWATHI
Middle Name:R
Last Name:PASHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWATHI
Other - Middle Name:
Other - Last Name:DUMBALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:STE 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:ST JOHN HOSPITAL
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48236
Practice Address - Country:US
Practice Address - Phone:734-464-0887
Practice Address - Fax:734-402-0254
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088042208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI70-0-F32947-0OtherBCBS CPIN #
MI1164663852Medicaid
MI70-0-F32947-0OtherBCBS CPIN #