Provider Demographics
NPI:1518985266
Name:LINGAM, VENKATA R (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATA
Middle Name:R
Last Name:LINGAM
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 1:30901 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-9529
Mailing Address - Country:US
Mailing Address - Phone:734-367-8444
Mailing Address - Fax:734-722-9524
Practice Address - Street 1:30901 PALMER RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-9529
Practice Address - Country:US
Practice Address - Phone:734-367-8444
Practice Address - Fax:734-722-9524
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010499672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1508883299OtherWRPH
MI4867244Medicaid
MI260Q26259OtherBCBSM GR#
MIVL049967OtherLICENSE
MIVL049967OtherLICENSE
MI4867244Medicaid