Provider Demographics
NPI:1548232788
Name:KRISHNAN, RAJAN SESHADRI (M D)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:SESHADRI
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22301 FOSTER WINTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3707
Mailing Address - Country:US
Mailing Address - Phone:248-552-0620
Mailing Address - Fax:248-552-0286
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:ALICE GUSTAFSON CENTER STE 202
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5023
Practice Address - Country:US
Practice Address - Phone:284-858-2270
Practice Address - Fax:248-335-6171
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK031968174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist