Healthcare Provider Details

I. General information

NPI: 1295985497
Provider Name (Legal Business Name): LAWRENCE RAJAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W CLAIREMONT AVE
EAU CLAIRE WI
54701-6122
US

IV. Provider business mailing address

719 W HAMILTON AVE STE B
EAU CLAIRE WI
54701-6970
US

V. Phone/Fax

Practice location:
  • Phone: 715-717-4121
  • Fax:
Mailing address:
  • Phone: 715-552-9784
  • Fax: 715-835-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number74096
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number47838
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number47838
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: