Provider Demographics
NPI:1437110590
Name:RAGHUNATHAN, MEERA (MD)
Entity type:Individual
Prefix:DR
First Name:MEERA
Middle Name:
Last Name:RAGHUNATHAN
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 1:6231 N CANTON CENTER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2693
Mailing Address - Country:US
Mailing Address - Phone:734-455-0800
Mailing Address - Fax:734-455-0818
Practice Address - Street 1:6231 N CANTON CENTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2694
Practice Address - Country:US
Practice Address - Phone:734-455-0800
Practice Address - Fax:734-455-0818
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR053059208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI202528412OtherTAX ID
MI4763482Medicaid