Provider Demographics
NPI:1164627931
Name:JEHANGIR N RAO, M.D., P.C.
Entity Type:Organization
Organization Name:JEHANGIR N RAO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEHANGIR
Authorized Official - Middle Name:N
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:248-535-1516
Mailing Address - Street 1:3771 LOCH BEND DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4337
Mailing Address - Country:US
Mailing Address - Phone:248-535-1516
Mailing Address - Fax:
Practice Address - Street 1:35180 NANKIN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2092
Practice Address - Country:US
Practice Address - Phone:734-261-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJR033622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1008266231OtherBCBSM
MIJR033622OtherLICENSE
MIJR033622OtherLICENSE
MIN24820001Medicare ID - Type Unspecified