Provider Demographics
NPI:1861419681
Name:RAM SURENDRAN M.D. PC
Entity type:Organization
Organization Name:RAM SURENDRAN M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURENDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-759-5460
Mailing Address - Street 1:1349 SOUTH ROCHESTER ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3151
Mailing Address - Country:US
Mailing Address - Phone:248-759-5460
Mailing Address - Fax:248-923-2446
Practice Address - Street 1:1349 S ROCHESTER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3151
Practice Address - Country:US
Practice Address - Phone:248-759-5460
Practice Address - Fax:248-923-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIH91969Medicare UPIN