1548232788 NPI number — DR. RAJAN SESHADRI KRISHNAN M D

Table of content: DR. RAJAN SESHADRI KRISHNAN M D (NPI 1548232788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548232788 NPI number — DR. RAJAN SESHADRI KRISHNAN M D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISHNAN
Provider First Name:
RAJAN
Provider Middle Name:
SESHADRI
Provider Name Prefix Text:
DR.
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:
1548232788
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22301 FOSTER WINTER DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48075-3707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-552-0620
Provider Business Mailing Address Fax Number:
248-552-0286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44405 WOODWARD AVE
Provider Second Line Business Practice Location Address:
ALICE GUSTAFSON CENTER STE 202
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341-5023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
284-858-2270
Provider Business Practice Location Address Fax Number:
248-335-6171
Provider Enumeration Date:
02/02/2006

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: 174400000X , with the licence number:  RK031968 , 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)





Copyright © 2007-2025 www.npivalidator.com