Provider Demographics
NPI:1689985079
Name:PULLALAREVU, RAGHAVESH (MD)
Entity Type:Individual
Prefix:
First Name:RAGHAVESH
Middle Name:
Last Name:PULLALAREVU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:130 TOWN CENTER DR STE 203
Mailing Address - Street 2:BEAUMONT MEDICAL STAFF AFFAIRS
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1744
Mailing Address - Country:US
Mailing Address - Phone:248-585-8218
Mailing Address - Fax:248-585-8266
Practice Address - Street 1:3535 W 13 MILE RD STE 644
Practice Address - Street 2:BEAUMONT MULTI-ORGAN TRANSPLANT CLINIC
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6770
Practice Address - Country:US
Practice Address - Phone:800-253-5592
Practice Address - Fax:248-551-2125
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2016-06-23
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Provider Licenses
StateLicense IDTaxonomies
PAMT 198189207R00000X
MI4301110236207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine