Healthcare Provider Details

I. General information

NPI: 1124130299
Provider Name (Legal Business Name): RAJALAKSHMI SANKARAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 NORKO DR
FLINT MI
48507-3027
US

IV. Provider business mailing address

5205 NORKO DR
FLINT MI
48507-3027
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-0400
  • Fax: 810-733-8638
Mailing address:
  • Phone: 810-733-0400
  • Fax: 810-733-8638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRS043426
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: