Healthcare Provider Details

I. General information

NPI: 1689651143
Provider Name (Legal Business Name): MICHAEL J RAJKUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 LAFAYETTE ST
NORWICH CT
06360-2737
US

IV. Provider business mailing address

112 LAFAYETTE ST
NORWICH CT
06360-2737
US

V. Phone/Fax

Practice location:
  • Phone: 860-886-8545
  • Fax: 855-629-7856
Mailing address:
  • Phone: 860-886-8545
  • Fax: 855-629-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number038660
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: