1851349682 NPI number — RAJ JEEVAN M.D.

Table of content: RAJ JEEVAN M.D. (NPI 1851349682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851349682 NPI number — RAJ JEEVAN M.D.

Organization/Personal Information

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

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:
1851349682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1625 N 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TERRE HAUTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47804-4067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-232-8716
Provider Business Mailing Address Fax Number:
812-232-7768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 N 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TERRE HAUTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47804-4067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-232-8716
Provider Business Practice Location Address Fax Number:
812-232-7768
Provider Enumeration Date:
05/04/2006

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: 207RN0300X , with the licence number:  01030797 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4954272007 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000084502 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".