Provider Demographics
NPI:1801183561
Name:RAJLICH, REBEKAH IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:IRENE
Last Name:RAJLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBEKAH
Other - Middle Name:IRENE
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 LAFAYETTE AVE SE # 4000
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4600
Mailing Address - Country:US
Mailing Address - Phone:616-685-6922
Mailing Address - Fax:
Practice Address - Street 1:300 LAFAYETTE AVE SE # 4000
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4600
Practice Address - Country:US
Practice Address - Phone:616-685-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099219207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine