Provider Demographics
NPI:1972096055
Name:KHEMRAJ, RAVI KUMAR (DO)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:KUMAR
Last Name:KHEMRAJ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11319 HEMINGWAY
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-2259
Mailing Address - Country:US
Mailing Address - Phone:416-666-7508
Mailing Address - Fax:
Practice Address - Street 1:44250 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1002
Practice Address - Country:US
Practice Address - Phone:248-964-0400
Practice Address - Fax:248-964-0401
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty