Provider Demographics
NPI:1346397411
Name:RAILAN, PAAVAN P (MD)
Entity Type:Individual
Prefix:
First Name:PAAVAN
Middle Name:P
Last Name:RAILAN
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 1:26901 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1971
Mailing Address - Country:US
Mailing Address - Phone:586-774-3200
Mailing Address - Fax:
Practice Address - Street 1:26901 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1971
Practice Address - Country:US
Practice Address - Phone:586-774-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI041522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3123004Medicaid
MIA76227Medicare UPIN
MI3123004Medicaid