Provider Demographics
NPI:1265406623
Name:RAJARAMAN, RAJAGOPALAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAJAGOPALAN
Middle Name:
Last Name:RAJARAMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:
Other - Last Name:RAJARAMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:25426 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-6200
Mailing Address - Country:US
Mailing Address - Phone:313-295-4710
Mailing Address - Fax:313-295-4713
Practice Address - Street 1:25426 GODDARD RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6200
Practice Address - Country:US
Practice Address - Phone:313-295-4710
Practice Address - Fax:313-295-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRR043376207Y00000X, 207YP0228X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2925008Medicaid
MI0822031Medicare ID - Type Unspecified
MIA79159Medicare UPIN