Provider Demographics
NPI:1588623763
Name:POPAT, RAJAN U (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAN
Middle Name:U
Last Name:POPAT
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 1:17707 GALLOWAY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2487
Mailing Address - Country:US
Mailing Address - Phone:248-763-3681
Mailing Address - Fax:
Practice Address - Street 1:17707 GALLOWAY FOREST DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2487
Practice Address - Country:US
Practice Address - Phone:248-763-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074186207PE0004X
TXN0375207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196397701Medicaid
MIRP074186OtherBC/BS OF MI
TX1588623763OtherTRICARE SOUTH
MI104418767Medicaid
TX196397702Medicaid
TX8BB105OtherBCBSTX
TX8CH530OtherBCBSTX
TXTXB104654Medicare Oscar/Certification
TX8CH530OtherBCBSTX
MIRP074186OtherBC/BS OF MI
TX8BB105OtherBCBSTX
TX196397702Medicaid
TX8K8907Medicare Oscar/Certification