Provider Demographics
NPI:1922001668
Name:RAJASEKARAN, SURENDER (MD)
Entity Type:Individual
Prefix:DR
First Name:SURENDER
Middle Name:
Last Name:RAJASEKARAN
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 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:MC 117
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-267-0118
Practice Address - Fax:616-267-0090
Is Sole Proprietor?:No
Enumeration Date:2005-05-26
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094493207L00000X, 207LC0200X, 2080P0203X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0089788Medicaid
AL009936283Medicaid
IN200213400AMedicaid
MS00375504Medicaid
LA1174840Medicaid
MO209260702Medicaid
OK200082050AMedicaid
ME422400000Medicaid
TN5440063Medicaid
OK200082050AMedicaid
TN5440063Medicaid