Basic Information
| Provider Information | |||||||||
| NPI: | 1548232788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRISHNAN | ||||||||
| FirstName: | RAJAN | ||||||||
| MiddleName: | SESHADRI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22301 FOSTER WINTER DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485520620 | ||||||||
| FaxNumber: | 2485520286 | ||||||||
| Practice Location | |||||||||
| Address1: | 44405 WOODWARD AVE | ||||||||
| Address2: | ALICE GUSTAFSON CENTER STE 202 | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483415023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2848582270 | ||||||||
| FaxNumber: | 2483356171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 02/24/2011 | ||||||||
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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 | 174400000X | RK031968 | MI | Y | Other Service Providers | Specialist |
No ID Information.