Individual
RAJ JEEVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1625 N 4TH ST, TERRE HAUTE, IN 47804-4067
(812) 232-8716
(812) 232-7768
Mailing address
1625 N 4TH ST, TERRE HAUTE, IN 47804-4067
(812) 232-8716
(812) 232-7768
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
01030797
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084502
ANTHEM BLUE CROSS BLUE SH
IN
05
—
4954272007
—
IL
Enumeration date
05/04/2006
Last updated
12/07/2007
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