=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902856677
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAJESH V IYER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3535 W 13 MILE RD #437
-----------------------------------------------------
City | ROYAL OAK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-288-2210
-----------------------------------------------------
Fax | 248-280-0505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30701 BARRINGTON SUITE 150 LMT CORPORATE OFFICE
-----------------------------------------------------
City | MADISON HEIGHTS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-616-1170
-----------------------------------------------------
Fax | 248-589-9875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 85980
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------