Healthcare Provider Details

I. General information

NPI: 1396768693
Provider Name (Legal Business Name): HARISH RAWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE SUITE 109
JACKSON MI
49201
US

IV. Provider business mailing address

900 E MICHIGAN AVE SUITE 109
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-0500
  • Fax: 517-782-1713
Mailing address:
  • Phone: 517-782-0500
  • Fax: 517-782-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberHR035017
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: