Organization
BIRMINGHAM SKIN & HAIR AESTHETICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VENKAT RUDRARAJU MD (OFFICIAL)
(248) 593-1000
Entity
Organization
Contact information
Practice address
751 CHESTNUT ST, SUITE 102, BIRMINGHAM, MI 48009-6461
(248) 593-1000
Mailing address
751 CHESTNUT ST, SUITE 102, BIRMINGHAM, MI 48009-6461
(248) 593-1000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4301067927
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4406149
—
MI
Enumeration date
01/09/2017
Last updated
01/09/2017
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