Individual
DR. RAGHURAM GOP ELLURU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.S.
Contact information
Practice address
7971 MOORSBRIDGE RD, PORTAGE, MI 49024-4075
(269) 329-2900
(269) 329-1408
Mailing address
7971 MOORSBRIDGE RD, PORTAGE, MI 49024-4075
(269) 329-2900
(269) 329-1408
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
RE071666
MI
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
RE071666
MI
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
4301071666
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C90475
BLUE CROSS/BLUE SHIELD
MI
Enumeration date
07/06/2005
Last updated
03/11/2026
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