Provider Demographics
NPI:1518365154
Name:GAYAM, SREEKANTH
Entity type:Individual
Prefix:
First Name:SREEKANTH
Middle Name:
Last Name:GAYAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 CEDAR KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-6424
Mailing Address - Country:US
Mailing Address - Phone:248-525-1500
Mailing Address - Fax:
Practice Address - Street 1:31400 HARLO DR
Practice Address - Street 2:APT # D
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-1980
Practice Address - Country:US
Practice Address - Phone:503-261-3918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-14
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist