Provider Demographics
NPI:1306047717
Name:JAGINI, JANARDHAN RAO (MD)
Entity type:Individual
Prefix:
First Name:JANARDHAN
Middle Name:RAO
Last Name:JAGINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29120 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1105
Mailing Address - Country:US
Mailing Address - Phone:248-355-3100
Mailing Address - Fax:348-354-8378
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:CHILDREN'S HOSPITAL, 3RD FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-9048
Practice Address - Fax:313-993-3879
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085240207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI519253910Medicaid
MI519559510Medicaid
MI519222510Medicaid
MI040E011990OtherBCBS OF MI
MI519253910Medicaid
MI0N10480005Medicare PIN
MI040E011990OtherBCBS OF MI