Healthcare Provider Details

I. General information

NPI: 1639184435
Provider Name (Legal Business Name): RS MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7980 LEWIS AVE
TEMPERANCE MI
48182-9580
US

IV. Provider business mailing address

7980 LEWIS AVE
TEMPERANCE MI
48182-9580
US

V. Phone/Fax

Practice location:
  • Phone: 734-847-3131
  • Fax: 734-847-4251
Mailing address:
  • Phone: 734-847-3131
  • Fax: 734-847-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301084149
License Number StateMI

VIII. Authorized Official

Name: DR. KRISHNA M RAGOTHAMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 419-847-3131