Healthcare Provider Details

I. General information

NPI: 1679535421
Provider Name (Legal Business Name): RAJESH D DAGLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 GULL RD STE 200
KALAMAZOO MI
49048-1638
US

IV. Provider business mailing address

1535 GULL RD STE 200
KALAMAZOO MI
49048-1638
US

V. Phone/Fax

Practice location:
  • Phone: 269-388-6350
  • Fax: 269-388-6360
Mailing address:
  • Phone: 269-388-6350
  • Fax: 269-388-6360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301 054003
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: