Healthcare Provider Details

I. General information

NPI: 1093972226
Provider Name (Legal Business Name): R RAJARAMAN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25426 GODDARD RD
TAYLOR MI
48180
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 Code261Q00000X
TaxonomyClinic/Center
License NumberRR043376
License Number StateMI

VIII. Authorized Official

Name: DR. RAJAGOPALAN RAJARAMAN
Title or Position: DR
Credential: M D
Phone: 313-295-4710