Provider Demographics
NPI:1346000841
Name:RAJU, RADUAN SULTAN
Entity Type:Individual
Prefix:
First Name:RADUAN
Middle Name:SULTAN
Last Name:RAJU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29658 VAN LAAN DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-4251
Mailing Address - Country:US
Mailing Address - Phone:586-565-4766
Mailing Address - Fax:
Practice Address - Street 1:29658 VAN LAAN DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4251
Practice Address - Country:US
Practice Address - Phone:586-565-4766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home