Individual
MALINI VENKATRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD .
Contact information
Practice address
4160 JOHN R ST, STE 917, DETROIT, MI 48201-2020
(313) 745-4525
(313) 745-0011
Mailing address
1420 STEPHENSON HWY, SUITE 400-CREDENTIALING, TROY, MI 48083-1189
(248) 581-5972
(248) 581-5640
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301085459
MI
207RR0500X
Rheumatology Physician
Primary
4301085459
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-0F3636-0
BCBSM GRP PIN
MI
01
—
1346398971
GRP NPI
MI
01
—
205485614
TAX ID
MI
05
—
5357970
—
MI
Enumeration date
01/27/2008
Last updated
11/08/2013
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