Provider Demographics
NPI:1811019458
Name:RAMISETTY, ROJA R (MD)
Entity Type:Individual
Prefix:
First Name:ROJA
Middle Name:R
Last Name:RAMISETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2912
Mailing Address - Country:US
Mailing Address - Phone:313-254-4039
Mailing Address - Fax:313-254-4071
Practice Address - Street 1:27211 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8469
Practice Address - Country:US
Practice Address - Phone:248-809-1001
Practice Address - Fax:248-809-1005
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082571207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315025246OtherCSR
BR9909295OtherFEDERAL DEA
MIMI10143033-MI10143Medicare PIN