Provider Demographics
NPI:1457410615
Name:VORAKKARA, BATHINAIAH RAJU (MD)
Entity type:Individual
Prefix:DR
First Name:BATHINAIAH
Middle Name:RAJU
Last Name:VORAKKARA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4466 W BRISTOL RD FL 2
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3170
Mailing Address - Country:US
Mailing Address - Phone:810-250-4866
Mailing Address - Fax:810-250-4867
Practice Address - Street 1:4466 W BRISTOL RD FL 2
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3170
Practice Address - Country:US
Practice Address - Phone:810-250-4866
Practice Address - Fax:810-250-4867
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091989207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000547713OtherANTHEM
KY1128934Medicaid
KY000000179725OtherANTHEM
KY64042294Medicaid
IN200311940AMedicaid
KY00546009Medicare PIN
KY000000547713OtherANTHEM
KY000000547713OtherANTHEM
KY000000179725OtherANTHEM
KYP00471819Medicare PIN
KY050079156Medicare ID - Type UnspecifiedRAILROAD MEDICARE