Provider Demographics
NPI:1689074007
Name:NARAYANAN, VENKATESH
Entity Type:Individual
Prefix:
First Name:VENKATESH
Middle Name:
Last Name:NARAYANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27534 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-3085
Mailing Address - Country:US
Mailing Address - Phone:313-748-3797
Mailing Address - Fax:248-336-9026
Practice Address - Street 1:27534 BRISTOL DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3085
Practice Address - Country:US
Practice Address - Phone:313-748-3797
Practice Address - Fax:248-336-9026
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501016848OtherMICHIGAN PHYSICAL THERAPY LICENSE NUMBER