Provider Demographics
NPI:1588783963
Name:VENKATASIVA PERAM MD, PC
Entity type:Organization
Organization Name:VENKATASIVA PERAM MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-720-0002
Mailing Address - Street 1:2222 S LINDEN RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5475
Mailing Address - Country:US
Mailing Address - Phone:810-720-0002
Mailing Address - Fax:810-720-0005
Practice Address - Street 1:2222 S LINDEN RD
Practice Address - Street 2:SUITE G
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5475
Practice Address - Country:US
Practice Address - Phone:810-720-0002
Practice Address - Fax:810-720-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070246207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P22260Medicare ID - Type Unspecified