Provider Demographics
NPI:1730563875
Name:JOSE L RAYGADA MD PLLC
Entity type:Organization
Organization Name:JOSE L RAYGADA MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:RAYGADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-948-4863
Mailing Address - Street 1:4641 E PICKARD ST STE A
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2189
Mailing Address - Country:US
Mailing Address - Phone:989-948-4863
Mailing Address - Fax:989-215-6501
Practice Address - Street 1:4641 E PICKARD ST STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2189
Practice Address - Country:US
Practice Address - Phone:989-948-4863
Practice Address - Fax:989-215-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty