MEDICARE: RAJ CLINICS PROFESSIONAL SERVICES CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1013072180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAJ CLINICS PROFESSIONAL SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	909 LAKEVIEW DR
Second Line	:
City	:	LOGANSPORT
State	:	IN
Zip	:	46947-2208
Country	:	US
Telephone Number	:	574-732-1166
Fax Number	:	574-753-4117

Provider Business Practice Location Address
First Line	:	315 AIRPORT NORTH OFFICE PARK
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-6703
Country	:	US
Telephone Number	:	574-732-1166
Fax Number	:	574-753-4117

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SITHA GITA KALAPATAPU
Credential	:	MD.,DGO.,FAPA.
Telephone Number	:	574-732-1166

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	10/23/2014

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