Provider Demographics
NPI:1992727028
Name:RAUT, TAPAN K (PT)
Entity type:Individual
Prefix:
First Name:TAPAN
Middle Name:K
Last Name:RAUT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29877 TELEGRAPH RD STE 303
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7660
Mailing Address - Country:US
Mailing Address - Phone:248-298-0433
Mailing Address - Fax:248-298-0434
Practice Address - Street 1:29877 TELEGRAPH RD STE 303
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7660
Practice Address - Country:US
Practice Address - Phone:248-298-0433
Practice Address - Fax:248-298-0434
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP9390001Medicare ID - Type Unspecified