Provider Demographics
NPI:1811933914
Name:PATIL, L RAJ S (MD)
Entity type:Individual
Prefix:DR
First Name:L RAJ
Middle Name:S
Last Name:PATIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:32905 W 12 MILE RD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-553-3150
Mailing Address - Fax:248-553-3150
Practice Address - Street 1:32905 W 12 MILE RD
Practice Address - Street 2:SUITE 450
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-553-3150
Practice Address - Fax:248-553-3150
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MILP032429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1067944Medicaid
MI1067944Medicaid
A74487Medicare UPIN