Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 4301059512 | MI |
NPI | 1003886151 |
---|---|
Provider Name | Dr. Rama V Thyagarajan |
First Address | Dearborn, MI 48126-2778 |
Second Address | Dearborn, MI 48124-4082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 15/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1108241691 | BLUE CROSS (01) | MI |
4751866 | (05) | MI |
G10622 | (02) | MI |