Provider Demographics
NPI:1356303093
Name:RAIJI, TUSHAR N (MD)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:N
Last Name:RAIJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0047
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-732-0891
Practice Address - Street 1:6203 COVERED WAGONS TRL
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-2170
Practice Address - Country:US
Practice Address - Phone:810-732-0288
Practice Address - Fax:810-732-0891
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301035669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1102557582OtherHEALTHPLUS
MI1102514291OtherBCBSM/BCN
MI110B56125OtherBLUE CROSS BLUE SHIELD
MI110B510530OtherCOMMUNITY BLUE
MIA76953OtherHAP
MIC1896OtherMCARE
MI4289801Medicaid
MI110B510530OtherBLUE CROSS BLUE SHIELD
MI110B510530OtherBLUE CHOICE
MI110B510530OtherBLUE CARE NETWORK
MIA76953OtherHEALTH NET FEDRAL SERVIC
MIA76953OtherHEALTH NET FEDRAL SERVIC
MIMI1137001Medicare PIN