Provider Demographics
NPI:1043327117
Name:RASTOGI, SANTOSH K (MD)
Entity type:Individual
Prefix:
First Name:SANTOSH
Middle Name:K
Last Name:RASTOGI
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 1:837 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5627
Mailing Address - Country:US
Mailing Address - Phone:248-879-6459
Mailing Address - Fax:248-828-9712
Practice Address - Street 1:27351 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3487
Practice Address - Country:US
Practice Address - Phone:248-967-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010490682084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI5414OtherMEDICARE PTAN GROUP
MI1093711459OtherNPI - CCC
MIMI5414001OtherMEDICARE PTAN INDIVIDUAL
MI3015553Medicaid
MI1093711459OtherNPI - CCC
MIMI5414OtherMEDICARE PTAN GROUP
06368112261Medicare ID - Type Unspecified