Provider Demographics
NPI:1790856326
Name:BHUPATHIRAJU, NARASIMHARAJU L (MD)
Entity Type:Individual
Prefix:DR
First Name:NARASIMHARAJU
Middle Name:L
Last Name:BHUPATHIRAJU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:B
Other - Middle Name:L
Other - Last Name:RAJU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:577 INKSTER RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-4117
Mailing Address - Country:US
Mailing Address - Phone:734-458-2111
Mailing Address - Fax:734-458-1955
Practice Address - Street 1:577 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-4117
Practice Address - Country:US
Practice Address - Phone:734-458-2111
Practice Address - Fax:734-458-1955
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINR0370412080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1094781Medicaid