Individual
PREM RAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
11509 SAINT AUBIN ST, HAMTRAMCK, MI 48212
(313) 926-2529
Mailing address
PO BOX 71772, MADISON HTS, MI 48071
(313) 926-2529
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5501005931
MI
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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