Provider Demographics
NPI:1336203603
Name:DANIEL, RAJAT (MD)
Entity type:Individual
Prefix:
First Name:RAJAT
Middle Name:
Last Name:DANIEL
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 1:1990 UNION LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2202
Mailing Address - Country:US
Mailing Address - Phone:248-363-7109
Mailing Address - Fax:248-363-7211
Practice Address - Street 1:1990 UNION LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2202
Practice Address - Country:US
Practice Address - Phone:248-363-7109
Practice Address - Fax:248-363-7211
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRD060871207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700F37550OtherBCBSM
MI3245750Medicaid
MIM89900050Medicare PIN
MIG23587Medicare UPIN