Provider Demographics
NPI:1932359197
Name:RAJESH D. DAGLI, M.D.
Entity Type:Organization
Organization Name:RAJESH D. DAGLI, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAGLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-278-1145
Mailing Address - Street 1:711 S HEALTH PKWY
Mailing Address - Street 2:SUITE L-7
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9387
Mailing Address - Country:US
Mailing Address - Phone:269-273-9789
Mailing Address - Fax:269-273-9611
Practice Address - Street 1:701 S HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8352
Practice Address - Country:US
Practice Address - Phone:269-278-1145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010540032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1355OtherMEDICARE PTAN - 701 S. HEALTH PARKWAY, THREE RIVERS, MI 49093
MI8008920590OtherBCBSM PIN - 701 S. HEALTH PARKWAY, THREE RIVERS, MI