Provider Demographics
NPI:1558330332
Name:KASMIKHA, RAAD P (MD)
Entity Type:Individual
Prefix:DR
First Name:RAAD
Middle Name:P
Last Name:KASMIKHA
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 1:1498 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1739
Mailing Address - Country:US
Mailing Address - Phone:248-652-1365
Mailing Address - Fax:248-652-1042
Practice Address - Street 1:1498 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1739
Practice Address - Country:US
Practice Address - Phone:248-652-1365
Practice Address - Fax:248-652-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3322358Medicaid
MI0M33330Medicare ID - Type Unspecified
MIF92178Medicare UPIN