Provider Demographics
NPI:1285035030
Name:CHANDRASEKARAN, JAYANTHI
Entity Type:Individual
Prefix:
First Name:JAYANTHI
Middle Name:
Last Name:CHANDRASEKARAN
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 1:28411 NORTHWESTERN HWY STE 1050
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5529
Mailing Address - Country:US
Mailing Address - Phone:855-442-2552
Mailing Address - Fax:247-354-4807
Practice Address - Street 1:28411 NORTHWESTERN HWY STE 1050
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:855-442-2552
Practice Address - Fax:247-354-4807
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.024105207R00000X
MI4301111660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine