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General NPI Number Information
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NPI Number | 1700886231
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Entity Type | Organization
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Legal Business Name | S. H. RAYTHATHA MD PC
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 4672 HILL ST
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City | CASS CITY
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State | MI
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Zip | 48726-1028
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Country | US
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Telephone | 989-872-5010
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Fax | 989-872-9942
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Provider Business Mailing Address
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Address Line | 4672 HILL ST
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City | CASS CITY
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State | MI
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Zip | 48726-1028
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Country | US
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Telephone | 989-872-5010
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Fax | 989-872-9942
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. SURENDRA HARIDAS RAYTHATHA
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Credential | MD
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Telephone | 989-872-5010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | SR040618
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License Number State | MI
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