Basic Information
| Provider Information | |||||||||
| NPI: | 1962484139 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHARAMRAJ | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 1254 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LAPEER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484461343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106644531 | ||||||||
| FaxNumber: | 8106677337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301042554 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 201569 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | C5691 | 01 | MI | MCARE | OTHER | 3640942004 | 01 | MI | CIGNA | OTHER | A78935 | 01 | MI | HEALTH NET FED SERVICES | OTHER | 0104255401 | 01 | MI | HEALTHPLUS | OTHER | 3504422641 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 201569 | 01 | MI | HEALTH ADVANTAGE | OTHER | 4568147 | 05 | MI | MEDICAID | 5604138 | 01 | MI | AETNA | OTHER | A78935 | 01 | MI | HAP | OTHER | 4494689 | 05 | MI | MEDICAID |