Individual
PAVAN BRAHMAMDAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3535 W 13 MILE RD STE 307, ROYAL OAK, MI 48073-6770
(248) 551-2400
(248) 551-6556
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1952
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
4301101193
MI
2086S0102X
Surgical Critical Care Physician
4301101193
MI
2086S0120X
Pediatric Surgery Physician
4301101193
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP1-0022823
INSTITUTIONAL PERMIT
—
Enumeration date
06/13/2007
Last updated
10/24/2023
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