Provider Demographics
NPI:1295790442
Name:RAMAKRISHNA, CHALAKUDY V (MD PC)
Entity type:Individual
Prefix:
First Name:CHALAKUDY
Middle Name:V
Last Name:RAMAKRISHNA
Suffix:
Gender:M
Credentials:MD PC
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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:734-422-5076
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:734-422-5076
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2013-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010492072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPTANOther0P03480
E37312Medicare UPIN