Provider Demographics
NPI:1558310441
Name:RAJAN, JAIRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIRAM
Middle Name:
Last Name:RAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 E MICHIGAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2111
Mailing Address - Country:US
Mailing Address - Phone:517-484-9050
Mailing Address - Fax:517-484-8169
Practice Address - Street 1:1433 E MICHIGAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2111
Practice Address - Country:US
Practice Address - Phone:517-484-9050
Practice Address - Fax:517-484-8169
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI042714207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI16003300212OtherBCBS OF MI
MI0700120OtherPHYSICIANS HEALTH PLAN
MI2692560 TYPE 10Medicaid
MIQMXPR0024536OtherMOLINA HEALTH CARE
MI0700120OtherPHYSICIANS HEALTH PLAN
MIA78236Medicare UPIN