Provider Demographics
NPI:1457542011
Name:RAMANATHAN, CHATHAPURAM S (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHATHAPURAM
Middle Name:S
Last Name:RAMANATHAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29220 WESTBROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5071
Mailing Address - Country:US
Mailing Address - Phone:248-790-8937
Mailing Address - Fax:
Practice Address - Street 1:29220 WESTBROOK PKWY
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5071
Practice Address - Country:US
Practice Address - Phone:248-790-8937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010722321041C0700X
MI4101005602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM 42420Medicare PIN