Provider Demographics
NPI:1306147384
Name:VIJAYA RAMESH M D P C
Entity type:Organization
Organization Name:VIJAYA RAMESH M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAMESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-271-8171
Mailing Address - Street 1:5633 WALNUT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2089
Mailing Address - Country:US
Mailing Address - Phone:313-271-8171
Mailing Address - Fax:248-661-3813
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:SUITE 311
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5032
Practice Address - Country:US
Practice Address - Phone:313-271-8171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010556042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF50564Medicare UPIN