Provider Demographics
NPI:1407844541
Name:PASTORIZA, RAJAN A (MD)
Entity Type:Individual
Prefix:
First Name:RAJAN
Middle Name:A
Last Name:PASTORIZA
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 1:1100 E MICHIGAN AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:577-787-6838
Mailing Address - Fax:577-787-5623
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:STE 205
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-787-6838
Practice Address - Fax:577-787-5623
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430107184207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0720038OtherPHP
1603802652OtherBCBS
MI4465589Medicaid
MI4465589Medicaid
0N91880001Medicare PIN