Provider Demographics
NPI:1003886151
Name:THYAGARAJAN, RAMA V (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMA
Middle Name:V
Last Name:THYAGARAJAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:15500 LUNDY PKWY
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2778
Mailing Address - Country:US
Mailing Address - Phone:313-586-5011
Mailing Address - Fax:313-792-7134
Practice Address - Street 1:18181 OAKWOOD BLVD STE 101
Practice Address - Street 2:MEDICAL OFFICE BUILDING
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4082
Practice Address - Country:US
Practice Address - Phone:313-436-2426
Practice Address - Fax:313-436-2440
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2014-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301059512207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4751866Medicaid
MI1108241691OtherBLUE CROSS
MI1108241691OtherBLUE CROSS
MIG10622Medicare UPIN