Provider Demographics
NPI:1790881605
Name:RASAKI, SEGUN MUFUTAU (MD)
Entity Type:Individual
Prefix:DR
First Name:SEGUN
Middle Name:MUFUTAU
Last Name:RASAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10574 IRON HORSE LANE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-0000
Mailing Address - Country:US
Mailing Address - Phone:317-245-8506
Mailing Address - Fax:317-926-9604
Practice Address - Street 1:3266 N MERIDIAN ST
Practice Address - Street 2:SUITE 601
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5846
Practice Address - Country:US
Practice Address - Phone:317-926-9600
Practice Address - Fax:317-926-9604
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94806207Q00000X
IN01061519A207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine