Provider Demographics
NPI:1275860314
Name:PACHIYANNAKIS, THALIA RAYA
Entity Type:Individual
Prefix:DR
First Name:THALIA
Middle Name:RAYA
Last Name:PACHIYANNAKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 N 2ND ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1351
Mailing Address - Country:US
Mailing Address - Phone:812-882-1000
Mailing Address - Fax:812-882-1004
Practice Address - Street 1:328 N 2ND ST
Practice Address - Street 2:SUITE 205
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1351
Practice Address - Country:US
Practice Address - Phone:812-882-1000
Practice Address - Fax:812-882-1004
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072322A207V00000X
MI4301094455207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1275860314OtherNPI
IN01072322AOtherIN LICENSE