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Individual

ETHIRAJ GOVINDA RAJ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1165 S LINDEN RD, FLINT, MI 48532-3406
(810) 732-5400
(810) 733-1624
Mailing address
1165 S LINDEN RD, FLINT, MI 48532-3406
(810) 732-5400
(810) 733-1624

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301039365
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0B51240
BLUE CROSS BLUE SHIELD MI
MI
01
0B51240, ER039365
BLUE CARE NETWORK
MI
01
1010892
MCLAREN HEALTH PLAN
MI
01
1100482
HEALTH PLUS OF MICHIGAN
MI
05
4591753
MI
01
C1855
MCARE
MI
01
ER039365
STATE LICENSE NUMBER
MI
Enumeration date
10/19/2005
Last updated
09/29/2011
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