Provider Demographics
NPI:1184632176
Name:NAIR, SREEKANT S (DO)
Entity Type:Individual
Prefix:
First Name:SREEKANT
Middle Name:S
Last Name:NAIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:SREEDHARAN
Other - Last Name:NAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:31505 THIRTY TWO MILE ROAD
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062
Mailing Address - Country:US
Mailing Address - Phone:586-727-2761
Mailing Address - Fax:586-727-3120
Practice Address - Street 1:31505 THIRTY TWO MILE ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062
Practice Address - Country:US
Practice Address - Phone:586-727-2761
Practice Address - Fax:586-727-3120
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4679492Medicaid
I17057Medicare UPIN
N45020005Medicare ID - Type Unspecified