Provider Demographics
NPI:1649424409
Name:RAJA, IMRAN M (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:M
Last Name:RAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1225 FORT UNION BLVD
Mailing Address - Street 2:#215
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1889
Mailing Address - Country:US
Mailing Address - Phone:801-233-4200
Mailing Address - Fax:801-233-4239
Practice Address - Street 1:1225 FORT UNION BLVD
Practice Address - Street 2:#215
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-1889
Practice Address - Country:US
Practice Address - Phone:801-233-4200
Practice Address - Fax:801-233-4239
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2012-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT7471387-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry