Basic Information
| Provider Information | |||||||||
| NPI: | 1154368637 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | RAU | ||||||||
| FirstName: | SHIVA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4646 JOHN R ST | ||||||||
| Address2: | 11PC, PRIMARY CARE,JOHN D. DINGELL VA MEDICAL CENTER, | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135761000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4646 JOHN R ST | ||||||||
| Address2: | 11PC, PRIMARY CARE,JOHN D. DINGELL VA MEDICAL CENTER, | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482011916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135761000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 12/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301072554 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.