Provider Demographics
NPI:1225146046
Name:RAJESH, BRAHMAIAH P (MD)
Entity Type:Individual
Prefix:MR
First Name:BRAHMAIAH
Middle Name:P
Last Name:RAJESH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:306 E ELM ST
Mailing Address - Street 2:STE B
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2347
Mailing Address - Country:US
Mailing Address - Phone:989-224-2100
Mailing Address - Fax:989-224-0784
Practice Address - Street 1:306 E ELM ST
Practice Address - Street 2:STEB
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2347
Practice Address - Country:US
Practice Address - Phone:989-224-2100
Practice Address - Fax:989-224-0784
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIBR060307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1101914301OtherBCBS
MI4575965Medicaid
MI4575965Medicaid
MI1101914301OtherBCBS