Provider Demographics
NPI:1215093778
Name:VENKATARAMAN, PREETI (MD)
Entity type:Individual
Prefix:DR
First Name:PREETI
Middle Name:
Last Name:VENKATARAMAN
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 1:50002 STREAMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-2148
Mailing Address - Country:US
Mailing Address - Phone:646-271-6140
Mailing Address - Fax:
Practice Address - Street 1:50002 STREAMWOOD DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-2148
Practice Address - Country:US
Practice Address - Phone:646-271-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD76987208000000X, 208M00000X
NY2408692080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02808551Medicaid