1952746265 NPI number — RAJASHREE NATARAJAN AUD CCC-A INC

Table of content: (NPI 1952746265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952746265 NPI number — RAJASHREE NATARAJAN AUD CCC-A INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAJASHREE NATARAJAN AUD CCC-A INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1952746265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47480 CHELTENHAM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOVI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48374-3685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-449-6522
Provider Business Mailing Address Fax Number:
888-779-4701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25426 GODDARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-295-4710
Provider Business Practice Location Address Fax Number:
313-295-4713
Provider Enumeration Date:
05/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
NATARAJAN
Authorized Official First Name:
RAJASHREE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
248-449-6522

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  1601000395 , 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: OH29582 . This is a "BCBS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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