MEDICARE: RAJ AND MADHU P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0800X	Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2608276822	OTHER	MI	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255520292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAJ AND MADHU P.C.

Provider Business Mailing Address
First Line	:	220 W CONGRESS ST
Second Line	:	2ND FLOOR
City	:	DETROIT
State	:	MI
Zip	:	48226-3289
Country	:	US
Telephone Number	:	313-963-4979
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 W CONGRESS ST
Second Line	:	2ND FLOOR
City	:	DETROIT
State	:	MI
Zip	:	48226-3289
Country	:	US
Telephone Number	:	313-963-4979
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MADHUMALTI BHAVSAR
Credential	:	MD
Telephone Number	:	313-963-4979

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	12/30/2008

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