Provider Demographics
NPI:1336116078
Name:KERKAR, PRAMOD (MD)
Entity Type:Individual
Prefix:
First Name:PRAMOD
Middle Name:
Last Name:KERKAR
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 1:860 HIDDEN PINE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2409
Mailing Address - Country:US
Mailing Address - Phone:586-977-7246
Mailing Address - Fax:586-977-1492
Practice Address - Street 1:5456 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5110
Practice Address - Country:US
Practice Address - Phone:586-977-7246
Practice Address - Fax:586-977-1492
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053766207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3376063Medicaid
F39397Medicare UPIN
MI3376063Medicaid