Individual
RAJA S MAHIDHARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3900 ST FRANCIS WAY STE 200, LAFAYETTE, IN 47905-4940
(765) 775-2800
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01070300A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01070300A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201037400
—
IN
Enumeration date
09/20/2006
Last updated
03/11/2021
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