Provider Demographics
NPI:1568578193
Name:CHALAKUDY V. RAMAKRISHNA, M.D., P. C.
Entity Type:Organization
Organization Name:CHALAKUDY V. RAMAKRISHNA, M.D., P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHALAKUDY
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAMAKRISHNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-442-4748
Mailing Address - Street 1:17940 FARMINGTON RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4444
Mailing Address - Country:US
Mailing Address - Phone:734-422-4748
Mailing Address - Fax:
Practice Address - Street 1:17940 FARMINGTON RD
Practice Address - Street 2:SUITE 230
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4444
Practice Address - Country:US
Practice Address - Phone:734-422-4748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2608244372OtherBCBS #
MI4639070Medicaid
MI2609502402OtherBCBS GROUP PIN
MI260031606OtherRR MEDICARE
MI4639070Medicaid