Provider Demographics
NPI:1093972226
Name:R RAJARAMAN MD
Entity Type:Organization
Organization Name:R RAJARAMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAGOPALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:313-295-4710
Mailing Address - Street 1:25426 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6200
Mailing Address - Country:US
Mailing Address - Phone:313-295-4710
Mailing Address - Fax:313-295-4713
Practice Address - Street 1:25426 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:313-295-4710
Practice Address - Fax:313-295-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRR043376261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0822031Medicare PIN
MIA79159Medicare UPIN