Provider Demographics
NPI:1750161246
Name:ALTAEE, RAJA KAMAL
Entity type:Individual
Prefix:
First Name:RAJA
Middle Name:KAMAL
Last Name:ALTAEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 KENILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2154
Mailing Address - Country:US
Mailing Address - Phone:313-452-3565
Mailing Address - Fax:
Practice Address - Street 1:1605 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-1915
Practice Address - Country:US
Practice Address - Phone:313-382-7861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511170601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical