Provider Demographics
NPI:1487641148
Name:RAMA, KUMARA (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMARA
Middle Name:
Last Name:RAMA
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 1:23829 LITTLE MACK
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1113
Mailing Address - Country:US
Mailing Address - Phone:586-772-4444
Mailing Address - Fax:586-772-4411
Practice Address - Street 1:23829 LITTLE MACK
Practice Address - Street 2:SUITE 200
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1113
Practice Address - Country:US
Practice Address - Phone:586-772-4444
Practice Address - Fax:586-772-4411
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010402502086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1846939Medicaid
020H21281OtherBCBS
MI0N55190Medicare ID - Type Unspecified
D72790Medicare UPIN