Provider Demographics
NPI:1902955966
Name:JOSE, RAJI (MD)
Entity Type:Individual
Prefix:MS
First Name:RAJI
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1051 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532
Mailing Address - Country:US
Mailing Address - Phone:810-720-1730
Mailing Address - Fax:810-720-1736
Practice Address - Street 1:401 S BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532
Practice Address - Country:US
Practice Address - Phone:810-720-1730
Practice Address - Fax:810-720-1736
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061959207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
EM033063OtherHEALTH ALLIANCE PLAN
050B56043OtherBLUE CROSS BLUE SHIELD
252506OtherMCLAREN HEALTH ADVANTAG
104052OtherGREAT LAKES HEALTH PLAN
1172870001OtherTHE WELLNESS PLAN
252506OtherMCLAREN HEALTH PLAN
567564OtherSELECT C ARE
G32019OtherAETNA HEALTH CARE
0996930OtherHEALTH PLUS OF MICHIGAN
30946OtherCOMMUNITY CHOICE OF MI M
MI4110127Medicaid
AN250004OtherMCARE INC
RJ061959OtherSTATE LICENSE NUMBER
30946OtherCOMMUNITY CHOICE OF MI M
0996930OtherHEALTH PLUS OF MICHIGAN