Provider Demographics
NPI:1699866509
Name:GULATI, RAJESH CHANDER (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:CHANDER
Last Name:GULATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJESH
Other - Middle Name:C
Other - Last Name:GULATI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2050 N HAGGERTY RD STE B2
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3795
Mailing Address - Country:US
Mailing Address - Phone:734-326-0740
Mailing Address - Fax:734-326-0785
Practice Address - Street 1:2050 N HAGGERTY RD STE B2
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3795
Practice Address - Country:US
Practice Address - Phone:734-326-0740
Practice Address - Fax:734-326-0785
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035830207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4466165Medicaid
MION18230Medicare ID - Type Unspecified
MI4466165Medicaid