Provider Demographics
NPI:1851349682
Name:JEEVAN, RAJ (MD)
Entity Type:Individual
Prefix:
First Name:RAJ
Middle Name:
Last Name:JEEVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-4067
Mailing Address - Country:US
Mailing Address - Phone:812-232-8716
Mailing Address - Fax:812-232-7768
Practice Address - Street 1:1625 N 4TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-4067
Practice Address - Country:US
Practice Address - Phone:812-232-8716
Practice Address - Fax:812-232-7768
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030797207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4954272007Medicaid
IN000000084502OtherANTHEM BLUE CROSS BLUE SH
IL4954272007Medicaid
IND95776Medicare UPIN
IN000000084502OtherANTHEM BLUE CROSS BLUE SH