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NPI Code Detail

MEDICARE: JOASH AJAY RAJ MD

MEDICARE: JOASH AJAY RAJ MD
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
1208000000XPediatrics Physician4301080648MI

General Provider Information

NPI Number : 1487642021
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOASH AJAY RAJ MD
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE
Second Line : MC 845
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3152 PORT SHELDON ST
Second Line : SUITE C
City : HUDSONVILLE
State : MI
Zip : 49426-9297
Country : US
Telephone Number : 616-669-9238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2005
Last Update Date : 02/19/2021

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