Healthcare Provider Details

I. General information

NPI: 1902856677
Provider Name (Legal Business Name): RAJESH V IYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAJESH VISWANATHAN

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD #437
ROYAL OAK MI
48073
US

IV. Provider business mailing address

30701 BARRINGTON SUITE 150 LMT CORPORATE OFFICE
MADISON HEIGHTS MI
48071
US

V. Phone/Fax

Practice location:
  • Phone: 248-288-2210
  • Fax: 248-280-0505
Mailing address:
  • Phone: 248-616-1170
  • Fax: 248-589-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number85980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: