Basic Information
| Provider Information | |||||||||
| NPI: | 1447754007 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAJARAM MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15312 KESTRAL LAKE DR | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730139695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056379438 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 S BRYANT AVE | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4056223063 | ||||||||
| FaxNumber: | 4057320022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2018 | ||||||||
| LastUpdateDate: | 05/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | RAJARAM | ||||||||
| AuthorizedOfficialFirstName: | VENKATARAMAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4056223063 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 28679 | OK | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.