1134192560 NPI number — RAKA MAHAJAN M.D.

Table of content: RAKA MAHAJAN M.D. (NPI 1134192560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134192560 NPI number — RAKA MAHAJAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAHAJAN
Provider First Name:
RAKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134192560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23500 PARK ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-2598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-292-3500
Provider Business Practice Location Address Fax Number:
313-292-3503
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RA0201X , with the licence number:  RM043153 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1108224641 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1566855 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 019394 . This is a "MIDWEST HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 110167981 . This is a "TRAVELERS MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: C3278 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000003118 . This is a "CAPE HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com