Provider Demographics
NPI:1760603047
Name:RAJAGOPAL, ANITHA (NP)
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:RAJAGOPAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 WYNGATE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6546
Mailing Address - Country:US
Mailing Address - Phone:248-879-1543
Mailing Address - Fax:
Practice Address - Street 1:2200 N SQUIRREL RD
Practice Address - Street 2:OAKLAND UNIVERSITY
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-4402
Practice Address - Country:US
Practice Address - Phone:248-370-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704202252363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care