Provider Demographics
NPI:1790758845
Name:RAJOULH, IBTIHAJ (MD)
Entity Type:Individual
Prefix:
First Name:IBTIHAJ
Middle Name:
Last Name:RAJOULH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4757 MCLEOD DR E
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604
Mailing Address - Country:US
Mailing Address - Phone:989-797-3130
Mailing Address - Fax:989-797-3124
Practice Address - Street 1:4757 MCLEOD DR E
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604
Practice Address - Country:US
Practice Address - Phone:989-797-3130
Practice Address - Fax:989-797-3124
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301056947207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4297376Medicaid
MI0807354772OtherBCBSM
MI0807354772OtherBCBSM
MION28030Medicare ID - Type Unspecified