Provider Demographics
NPI:1669692513
Name:DR SEGUN RASAKI MD LLC
Entity type:Organization
Organization Name:DR SEGUN RASAKI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SEGUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-926-9600
Mailing Address - Street 1:3266 N MERIDIAN ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-5846
Mailing Address - Country:US
Mailing Address - Phone:317-926-9600
Mailing Address - Fax:317-926-9604
Practice Address - Street 1:3266 N MERIDIAN ST
Practice Address - Street 2:SUITE 601
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5846
Practice Address - Country:US
Practice Address - Phone:317-926-9600
Practice Address - Fax:317-926-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061519A207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty