Provider Demographics
NPI:1063623981
Name:RAYGADA, JOSE LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:RAYGADA
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 1:4641 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
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083444207R00000X, 207RI0200X
MI5315042575207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1103700032OtherBCBSM
MI1051580OtherMCLAREN
MI200000021994OtherPHP COMMERCIAL
MI1051580OtherMCLAREN
MIM17400031Medicare PIN