Provider Demographics
NPI:1790872711
Name:SIVARAMAKRISHNAN, PARVATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVATHI
Middle Name:
Last Name:SIVARAMAKRISHNAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 LOCHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0734
Mailing Address - Country:US
Mailing Address - Phone:248-682-3300
Mailing Address - Fax:348-682-0026
Practice Address - Street 1:2561 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3313
Practice Address - Country:US
Practice Address - Phone:248-682-3300
Practice Address - Fax:248-682-0026
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066648208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIO1003206OtherHEALTH PLUS
MI3506354231OtherBCBSM
MI153996OtherGREAT LAKES HEALTH PLAN
MI6U4828OtherHAP
MI142662OtherCARE CHOICES
MI37975OtherHEALTH PLAN OF MICHIGAN
MI4817930Medicaid
MI17545OtherMCARE
MI4817959Medicaid