Birmingham Skin & Hair Aesthetics PLLC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

4301067927 Issued in MA

Legal business name

BIRMINGHAM SKIN & HAIR AESTHETICS PLLC

Practice address

751 Chestnut St
Suite 102
Birmingham, MI 48009-6461

Phone

(248) 593-1000

NPI assigned

Jan 9, 2017

Last updated

Jan 9, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Venkat Rudraraju, MD

Title

Official

Phone

(248) 593-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1720524218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 CHESTNUT ST",
            "address_2": "SUITE 102",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096461",
            "telephone_number": "248-593-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 CHESTNUT ST",
            "address_2": "SUITE 102",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096461",
            "telephone_number": "248-593-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRMINGHAM SKIN & HAIR AESTHETICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-09",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "RUDRARAJU",
        "authorized_official_first_name": "VENKAT",
        "authorized_official_title_or_position": "OFFICIAL",
        "authorized_official_telephone_number": "248-593-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MA",
            "license": "4301067927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4406149",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Birmingham Urological Associates, P.C.
• Birmingham Wellness Center PLLC

• Medical Physician Assistant in Birmingham, MI
• Providers in Birmingham, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.