Provider Demographics
NPI:1205863867
Name:MADHAVAN, RAMESH
Entity type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:MADHAVAN
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 1:43902 WOODWARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5021
Mailing Address - Country:US
Mailing Address - Phone:248-955-9949
Mailing Address - Fax:248-928-2274
Practice Address - Street 1:6255 INKSTER RD STE 101
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2538
Practice Address - Country:US
Practice Address - Phone:248-955-9949
Practice Address - Fax:248-928-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010774282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630452Medicare PIN