Provider Demographics
NPI:1326133315
Name:VELAGALETI, RAGHAVA S (MD)
Entity Type:Individual
Prefix:
First Name:RAGHAVA
Middle Name:S
Last Name:VELAGALETI
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 1:1000 HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5303
Mailing Address - Country:US
Mailing Address - Phone:989-583-6800
Mailing Address - Fax:989-583-6915
Practice Address - Street 1:1000 HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5303
Practice Address - Country:US
Practice Address - Phone:989-583-6800
Practice Address - Fax:989-583-6915
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204842207P00000X, 207RC0000X, 207RI0011X
MI4301069949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110215141OtherRAILROAD MEDICARE
MI0730385OtherBCBSM
MI0990073OtherHEALTHPLUS
MI700G360210OtherBCBSM
MI42993OtherCOMMUNITY CHOICE MICHIGAN
MI381870664OtherTAX ID
MI4239372Medicaid
MARV069949OtherLICENSE
MI102941OtherGREAT LAKES HEALTH PLAN