Provider Demographics
NPI:1003931528
Name:RAJKUMAR, SUNDERAJ (PT)
Entity Type:Individual
Prefix:MR
First Name:SUNDERAJ
Middle Name:
Last Name:RAJKUMAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53760 GENERATIONS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1539
Mailing Address - Country:US
Mailing Address - Phone:574-247-4444
Mailing Address - Fax:574-243-5555
Practice Address - Street 1:2222 W. LEXINGTON
Practice Address - Street 2:SUITE B
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1420
Practice Address - Country:US
Practice Address - Phone:574-522-2242
Practice Address - Fax:574-522-2527
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003004A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20058DMedicare PIN