Individual provider Active NPI

Preeti Venkataraman, MD

  • Psychiatry Physician
  • Dearborn, MI
National Provider Identifier
1902830193
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301060470 Issued in MI
Practice address
5111 Auto Club Dr
#120
Dearborn, MI 48126-2749
Phone
(313) 583-0735
Fax
(313) 583-0751
NPI assigned
Jul 11, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 4301060470 MI Primary

Addresses

Primary practice location

5111 Auto Club Dr
#120
Dearborn, MI 48126-2749

Mailing address

28000 Dequindre Rd
Warren, MI 48092-2468
Phone (586) 753-0405

Other names 1

  • Preeti Srivastava Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301060470MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Eastwood Behavioral Health Past Accepting new patients
Bca of Detroit, LLC Past Accepting new patients

Organizations & group practices 2

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902830193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922468",
            "telephone_number": "586-753-0405",
            "fax_number": "586-753-0404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 AUTO CLUB DR",
            "address_2": "#120",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262749",
            "telephone_number": "313-583-0735",
            "fax_number": "313-583-0751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENKATARAMAN",
        "first_name": "PREETI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301060470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PREETI",
            "last_name": "SRIVASTAVA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.