Provider Demographics
NPI:1679535421
Name:DAGLI, RAJESH D (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
Middle Name:D
Last Name:DAGLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 GULL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1638
Mailing Address - Country:US
Mailing Address - Phone:269-388-6350
Mailing Address - Fax:269-388-6360
Practice Address - Street 1:1535 GULL RD STE 200
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1638
Practice Address - Country:US
Practice Address - Phone:269-388-6350
Practice Address - Fax:269-388-6360
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301 0540032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4733741Medicaid
MIMI1355OtherMEDICARE PTAN - THREE RIVERS HEALTH
MI8008920590OtherBCBSM PIN - THREE RIVERS
MI1994510Medicaid
MI1994510Medicaid
MI4733741Medicaid
MIMI1355OtherMEDICARE PTAN - THREE RIVERS HEALTH