Provider Demographics
NPI:1922009075
Name:RAJU, SENTHIL K (MD)
Entity Type:Individual
Prefix:
First Name:SENTHIL
Middle Name:K
Last Name:RAJU
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 1:1145 W I 240 SERVICE RD STE F100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2134
Mailing Address - Country:US
Mailing Address - Phone:405-513-4591
Mailing Address - Fax:405-265-5230
Practice Address - Street 1:1145 W I 240 SERVICE RD STE F100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2134
Practice Address - Country:US
Practice Address - Phone:405-513-4591
Practice Address - Fax:405-265-5230
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301078867207Q00000X
OK26716207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200220110AMedicaid
MI4700802Medicaid
OKOK401736Medicare PIN
MI0G46288016Medicare PIN
I07063Medicare UPIN