1992983936 NPI number — MRS. RAJALAKSHMI A AGRAWAL MD

Table of content: MRS. RAJALAKSHMI A AGRAWAL MD (NPI 1992983936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992983936 NPI number — MRS. RAJALAKSHMI A AGRAWAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGRAWAL
Provider First Name:
RAJALAKSHMI
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1992983936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1080 SOUTH VAN DYKE ROAD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BAD AXE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48413-9001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-269-8824
Provider Business Mailing Address Fax Number:
929-269-8825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1080 SOUTH VAN DYKE ROAD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BAD AXE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48413-9001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-269-8824
Provider Business Practice Location Address Fax Number:
929-269-8825
Provider Enumeration Date:
02/01/2008

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: 171100000X , with the licence number:  4301038421 , 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: 0503210092 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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