MEDICARE: RAKA MAHAJAN M.D.

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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	RM043153	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110167981	OTHER	MN	TRAVELERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1108224641	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	019394	OTHER	MI	MIDWEST HEALTH
5	C3278	OTHER	MI	MCARE
6	000000003118	OTHER	MI	CAPE HEALTH

General Provider Information

NPI Number	:	1134192560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAKA MAHAJAN M.D.

Provider Business Mailing Address
First Line	:	23500 PARK ST
Second Line	:	SUITE 3
City	:	DEARBORN
State	:	MI
Zip	:	48124-2598
Country	:	US
Telephone Number	:	313-292-3500
Fax Number	:	313-292-3503

Provider Business Practice Location Address
First Line	:	23500 PARK ST
Second Line	:	SUITE 3
City	:	DEARBORN
State	:	MI
Zip	:	48124-2598
Country	:	US
Telephone Number	:	313-292-3500
Fax Number	:	313-292-3503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	03/18/2014

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Directions to “ RAKA MAHAJAN M.D.” Practice Location

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