Healthcare Provider Details

I. General information

NPI: 1730674813
Provider Name (Legal Business Name): RAISA RAZALAN-CLAREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAISA RAZALAN MD

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MICHIGAN ST NE STE 4200
GRAND RAPIDS MI
49503-2559
US

IV. Provider business mailing address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

V. Phone/Fax

Practice location:
  • Phone: 616-267-9150
  • Fax:
Mailing address:
  • Phone: 314-577-5680
  • Fax: 314-577-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301514311
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: