MEDICARE: DR. PRADEEP NAGARAJU MD

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	208800000X	Urology Physician	4301083042	MI
2	2088F0040X	Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician	4301083042	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PN083042	OTHER	MI	BCBSM LICENCE NUMBER
2	0E06273	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1285615583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRADEEP NAGARAJU MD

Provider Business Mailing Address
First Line	:	20952 E 12 MILE RD
Second Line	:	SUITE 200
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48081-3200
Country	:	US
Telephone Number	:	586-771-4820
Fax Number	:	586-771-6620

Provider Business Practice Location Address
First Line	:	3535 W 13 MILE RD
Second Line	:	SUITE 407
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6770
Country	:	US
Telephone Number	:	248-551-0638
Fax Number	:	248-355-1449

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

Provider Enumeration Date	:	11/14/2005
Last Update Date	:	09/11/2014

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