Provider Demographics
NPI:1538150842
Name:IYER, RAJARAMAN SUBRAMANIAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAJARAMAN
Middle Name:SUBRAMANIAN
Last Name:IYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10006 TANGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3836
Mailing Address - Country:US
Mailing Address - Phone:219-398-9265
Mailing Address - Fax:219-398-9265
Practice Address - Street 1:4320 FIR ST
Practice Address - Street 2:STE 208
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3052
Practice Address - Country:US
Practice Address - Phone:219-398-9265
Practice Address - Fax:219-398-9370
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055306208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200378620Medicaid
C38258Medicare UPIN