| Doctor Name: | DR. SANJEEV SHANMUGA VENKATARAMAN |
| NPI Number: | 1629120282 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | SV056477 |
| Business Practice Address: | 4111 Andover Rd Suite 220 Bloomfield Hills, MI - 483021909 |
| Business Phone Number: | 2482905400 |
| Business Fax Number: | 2482905401 |
| Mailing Address: | 4639 Ravine Dr, BLOOMFIELD HILLS |
| State: | MI |
| Postal Code: | 483013640 |
| Phone Number: | 2487374525 |
| Fax Number: | 2482905401 |
| NPI Enumeration Date: | 01/16/2007 |
| NPI Last Update Date: | 01/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2084A0401X |
| License Number: | SV056477 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Psychiatry & Neurology |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |