Provider Demographics
NPI:1255520292
Name:RAJ AND MADHU P.C.
Entity type:Organization
Organization Name:RAJ AND MADHU P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHUMALTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAVSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-963-4979
Mailing Address - Street 1:220 W CONGRESS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3289
Mailing Address - Country:US
Mailing Address - Phone:313-963-4979
Mailing Address - Fax:
Practice Address - Street 1:220 W CONGRESS ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3289
Practice Address - Country:US
Practice Address - Phone:313-963-4979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2608276822OtherBLUE CROSS
MI3318749Medicaid
MI3318749Medicaid
MI=========OtherTAX ID