Provider Demographics
NPI:1760557326
Name:JUPALLI, RAJASEKHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJASEKHAR
Middle Name:
Last Name:JUPALLI
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:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6204
Practice Address - Street 1:1210 W SAGINAW ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1927
Practice Address - Country:US
Practice Address - Phone:517-364-7700
Practice Address - Fax:517-364-7701
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010480422084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2603312291OtherINDIVIDUAL BCBS PIN NUMBE
MI2775789Medicaid
MI2603312291OtherINDIVIDUAL BCBS PIN NUMBE