Provider Demographics
NPI:1639305121
Name:RAJU, SRIHARI (MD)
Entity Type:Individual
Prefix:
First Name:SRIHARI
Middle Name:
Last Name:RAJU
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 1:12300 MARION LN W
Mailing Address - Street 2:APT# 2116
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1375
Mailing Address - Country:US
Mailing Address - Phone:612-743-6372
Mailing Address - Fax:
Practice Address - Street 1:12300 MARION LN W
Practice Address - Street 2:APT# 2116
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1375
Practice Address - Country:US
Practice Address - Phone:612-743-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program