Provider Demographics
NPI:1104973916
Name:RAJAN, KANTHI SANKAR (MD)
Entity type:Individual
Prefix:
First Name:KANTHI
Middle Name:SANKAR
Last Name:RAJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 KERCHEVAL AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3629
Mailing Address - Country:US
Mailing Address - Phone:313-882-7900
Mailing Address - Fax:313-640-2253
Practice Address - Street 1:131 KERCHEVAL AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-3629
Practice Address - Country:US
Practice Address - Phone:313-882-7900
Practice Address - Fax:313-640-2253
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301069868208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262280OtherBLUE CROSS-BLUE CROSS
KR069868OtherCOMMERCIAL-COMMERCIAL NUMBER
KR069868OtherCHAMPUS-CHAMPUS
MI427186110Medicaid
KR069868OtherCHAMPUS-CHAMPUS
MI427186110Medicaid