Provider Demographics
NPI:1194835108
Name:NADARAJAH, GANGA D (MD)
Entity Type:Individual
Prefix:
First Name:GANGA
Middle Name:D
Last Name:NADARAJAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30061 SCHOENHERR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3133
Mailing Address - Country:US
Mailing Address - Phone:586-558-2111
Mailing Address - Fax:586-558-2169
Practice Address - Street 1:30061 SCHOENHERR RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3133
Practice Address - Country:US
Practice Address - Phone:586-558-2111
Practice Address - Fax:586-558-2169
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGN063751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4128462Medicaid
MIG55586Medicare UPIN