Provider Demographics
NPI:1992983936
Name:AGRAWAL, RAJALAKSHMI A (MD)
Entity type:Individual
Prefix:MRS
First Name:RAJALAKSHMI
Middle Name:A
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 SOUTH VAN DYKE ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9001
Mailing Address - Country:US
Mailing Address - Phone:989-269-8824
Mailing Address - Fax:929-269-8825
Practice Address - Street 1:1080 SOUTH VAN DYKE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9001
Practice Address - Country:US
Practice Address - Phone:989-269-8824
Practice Address - Fax:929-269-8825
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038421171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0503210092OtherBCBSM
MI0321009Medicare UPIN