Healthcare Provider Details

I. General information

NPI: 1265406623
Provider Name (Legal Business Name): RAJAGOPALAN RAJARAMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: R. RAJARAMAN M.D.

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25426 GODDARD RD
TAYLOR MI
48180-6200
US

IV. Provider business mailing address

25426 GODDARD RD
TAYLOR MI
48180-6200
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-4710
  • Fax: 313-295-4713
Mailing address:
  • Phone: 313-295-4710
  • Fax: 313-295-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberRR043376
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberRR043376
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberRR043376
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: