Provider Demographics
NPI:1780746602
Name:VR JASTY MD PLC
Entity type:Organization
Organization Name:VR JASTY MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:RAMANA
Authorized Official - Last Name:JASTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-484-7159
Mailing Address - Street 1:6720 BIRMINGHAM CLUB DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3119
Mailing Address - Country:US
Mailing Address - Phone:586-484-7159
Mailing Address - Fax:248-385-5771
Practice Address - Street 1:1525 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2675
Practice Address - Country:US
Practice Address - Phone:586-484-7159
Practice Address - Fax:248-385-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010573062084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4909747Medicaid
0P01920Medicare PIN