Individual provider Active NPI

Sanjeev Shanmuga Venkataraman, M.D.

  • Psychiatry Physician
  • Bloomfield Township, MI
National Provider Identifier
1629120282
Registry record updated Feb 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
SV056477 Issued in MI
Practice address
W-4111 Andover Rd Ste 125
Bloomfield Township, MI 48302-1931
Phone
(248) 737-4525
Fax
(248) 290-5401
NPI assigned
Jan 16, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X SV056477 MI Primary

Addresses

Primary practice location

W-4111 Andover Rd Ste 125
Bloomfield Township, MI 48302-1931

Mailing address

4639 Ravine Dr
Bloomfield Hills, MI 48301-3640
Phone (248) 737-4525

Other identifiers 1

IdentifierTypeStateIssuer
2852180MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060321000007 MI Practitioner - Psychiatry 3779599436 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

35031 23 Mile Rd
New Baltimore, MI 48047-3649
Phone (586) 725-5777

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
SV056477MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
PHC of Michigan LLC CurrentSince Sep 20, 2010 Accepting new patients
Sanjeev Venkataraman, MD, PLC Psychiatry CurrentSince Dec 30, 2014 Accepting new patients
PHC of Michigan, LLC Psychiatry CurrentSince Sep 20, 2010 Accepting new patients
Bloomfield Behavioral Health Associates PLLC Psychiatry Current Accepting new patients

Locations

W-4111 Andover Rd
Ste 100
Bloomfield Township, MI 48302
Phone (248) 290-5400

4111 Andover Rd
Ste 220
Bloomfield Township, MI 48302
Phone (248) 290-5400

W-4111 Andover Rd
Ste 125
Bloomfield Township, MI 48302
Phone (248) 737-4525

35031 23 Mile Rd
New Baltimore, MI 48047
Phone (586) 684-4870

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771200000000",
    "number": "1629120282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4639 RAVINE DR",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013640",
            "telephone_number": "248-737-4525",
            "fax_number": "248-290-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W-4111 ANDOVER RD STE 125",
            "city": "BLOOMFIELD TOWNSHIP",
            "state": "MI",
            "postal_code": "483021931",
            "telephone_number": "248-737-4525",
            "fax_number": "248-290-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENKATARAMAN",
        "first_name": "SANJEEV",
        "middle_name": "SHANMUGA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2026-02-16",
        "certification_date": "2026-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "SV056477",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2852180",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield Township, MI

Sources for this page

Verify at the official NPI Registry.