Provider Demographics
NPI:1851584585
Name:B.P. RAJESH, MD, PLLC
Entity Type:Organization
Organization Name:B.P. RAJESH, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-224-2100
Mailing Address - Street 1:306 E ELM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2336
Mailing Address - Country:US
Mailing Address - Phone:989-224-2100
Mailing Address - Fax:989-224-0784
Practice Address - Street 1:306 ELM STREET
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2068
Practice Address - Country:US
Practice Address - Phone:989-224-2100
Practice Address - Fax:989-224-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060307261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4575965Medicaid
MI11-0-A9-1027-0OtherBCBS OF MICHIGAN
MI11-0-A9-1027-0OtherBCBS OF MICHIGAN
MI4575965Medicaid
MION80180Medicare PIN