Provider Demographics
NPI:1033439807
Name:SEKHARAN, S RAJA (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:RAJA
Last Name:SEKHARAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 TIVERTON RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2347
Mailing Address - Country:US
Mailing Address - Phone:248-644-6863
Mailing Address - Fax:248-644-6863
Practice Address - Street 1:1950 TIVERTON RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2347
Practice Address - Country:US
Practice Address - Phone:248-644-6863
Practice Address - Fax:248-644-6863
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010317172082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA77535Medicare UPIN