Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | D76987 | MD |
N | 2080P0204X | Pediatric Emergency Doctor | 240869 | NY |
NPI | 1215093778 |
---|---|
Provider Name | Dr. Preeti Venkataraman |
First Address | Novi, MI 48374-2148 |
Second Address | Novi, MI 48374-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 25/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02808551 | (05) | NY |