Provider Demographics
NPI:1770786931
Name:VEMURI, PADMAJA (MD,)
Entity type:Individual
Prefix:DR
First Name:PADMAJA
Middle Name:
Last Name:VEMURI
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 1:24579 PERCEVAL LN
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2355
Mailing Address - Country:US
Mailing Address - Phone:248-347-3171
Mailing Address - Fax:248-347-3171
Practice Address - Street 1:18101 OAKWOOD BLVD,
Practice Address - Street 2:OAKWOOD HOSPITAL AND MEDICAL CENTER
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-982-5203
Practice Address - Fax:313-436-2071
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI# 4466245-10Medicaid
MI0828647OtherBLUE CROSS PPO
MI# 0H26239160Medicare ID - Type Unspecified
MI# 4466245-10Medicaid