Provider Demographics
NPI:1326116872
Name:PARASURAMAN, RAVIPRASENNA KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:RAVIPRASENNA
Middle Name:KUMAR
Last Name:PARASURAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:1ST FLOOR TAUBMAN CENTER RECP G
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5334
Practice Address - Country:US
Practice Address - Phone:800-333-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063101207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI347486010Medicaid
RP063101OtherCHAMPUS-CHAMPUS
700H262220OtherBLUE CROSS-BLUE CROSS
RP063101OtherCOMMERCIAL-COMMERCIAL NUMBER
0H26222561Medicare ID - Type Unspecified
G81082Medicare UPIN