Provider Demographics
NPI:1679507669
Name:SURENDRAN, RAMKRISHNA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMKRISHNA
Middle Name:
Last Name:SURENDRAN
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 1:1349 SOUTH ROCHESTER ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3151
Mailing Address - Country:US
Mailing Address - Phone:248-759-5460
Mailing Address - Fax:248-923-2446
Practice Address - Street 1:1349 SOUTH ROCHESTER ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3151
Practice Address - Country:US
Practice Address - Phone:248-759-5460
Practice Address - Fax:248-923-2446
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16320OtherMCARE NUMBER
MI7163493OtherAETNA PIN
MI0806319991OtherBCBSM AND BCN
MI137894OtherCARE CHOICES
MI4552497Medicaid
MI0806319991OtherBCBSM AND BCN
MI0N79060Medicare ID - Type UnspecifiedMEDICARE NUMBER