Provider Demographics
NPI:1265467682
Name:MALINENI, VENKATESWARA RAO (MD)
Entity Type:Individual
Prefix:
First Name:VENKATESWARA
Middle Name:RAO
Last Name:MALINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5341 PROVINCIAL DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:888-495-3999
Mailing Address - Fax:586-466-9972
Practice Address - Street 1:215 NORTH AVE
Practice Address - Street 2:ST JOSEPH SPECIALTY HOSPITAL 215
Practice Address - City:MT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48045
Practice Address - Country:US
Practice Address - Phone:586-466-9889
Practice Address - Fax:586-466-9972
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY283787-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI296306310Medicaid
MI2606320151OtherBC
MI0N33090Medicare ID - Type Unspecified