MEDICARE: ANITHA RAJAGOPAL NP

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	363LP2300X	Primary Care Nurse Practitioner	4704202252	MI

General Provider Information

NPI Number	:	1760603047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITHA RAJAGOPAL NP

Provider Business Mailing Address
First Line	:	1888 WYNGATE DR
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48098-6546
Country	:	US
Telephone Number	:	248-879-1543
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N SQUIRREL RD
Second Line	:	OAKLAND UNIVERSITY
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-4402
Country	:	US
Telephone Number	:	248-370-2341
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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