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NPI Code Detail

MEDICARE: S. H. RAYTHATHA MD PC

MEDICARE: S. H. RAYTHATHA MD PC
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
1207Q00000XFamily Medicine PhysicianSR040618MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10790012OTHERMIBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700886231
Entity Type Code : Organization
Provider Name (Legal Business Name) : S. H. RAYTHATHA MD PC
Provider Business Mailing Address
First Line : 4672 HILL ST
Second Line :
City : CASS CITY
State : MI
Zip : 48726-1028
Country : US
Telephone Number : 989-872-5010
Fax Number : 989-872-9942
Provider Business Practice Location Address
First Line : 4672 HILL ST
Second Line :
City : CASS CITY
State : MI
Zip : 48726-1028
Country : US
Telephone Number : 989-872-5010
Fax Number : 989-872-9942
Authorized Official
Title or Position : PRESIDENT/PHYSICIAN
Name : DR. SURENDRA HARIDAS RAYTHATHA
Credential : MD
Telephone Number : 989-872-5010
Provider Enumeration Date : 07/27/2005
Last Update Date : 08/25/2008

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