Provider Demographics
NPI:1114010238
Name:THYAGARAJ, ARADHANA (PA)
Entity Type:Individual
Prefix:
First Name:ARADHANA
Middle Name:
Last Name:THYAGARAJ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9911 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3110
Mailing Address - Country:US
Mailing Address - Phone:734-427-3769
Mailing Address - Fax:
Practice Address - Street 1:17000 KING RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1115
Practice Address - Country:US
Practice Address - Phone:734-362-9032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant