Provider Demographics
NPI:1558439737
Name:RASTOGI, SHAILAJA (MD)
Entity Type:Individual
Prefix:
First Name:SHAILAJA
Middle Name:
Last Name:RASTOGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 BARCLAY CIR
Practice Address - Street 2:150
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4555
Practice Address - Country:US
Practice Address - Phone:248-299-5777
Practice Address - Fax:248-299-6917
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI70F326980OtherBCBS
H76271Medicare UPIN
MIOP22250001Medicare PIN
MI0P22250001Medicare ID - Type Unspecified