Provider Demographics
NPI:1346035185
Name:RAJEEV, RADHIKA
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:RAJEEV
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROADWAY ST APT 239
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2988
Mailing Address - Country:US
Mailing Address - Phone:734-882-8058
Mailing Address - Fax:
Practice Address - Street 1:1200 BROADWAY ST APT 239
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2988
Practice Address - Country:US
Practice Address - Phone:734-882-8058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30178552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology