Provider Demographics
NPI:1518109420
Name:JEYAKUMAR, GHAYATHRI (MD)
Entity Type:Individual
Prefix:
First Name:GHAYATHRI
Middle Name:
Last Name:JEYAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GHAYA
Other - Middle Name:
Other - Last Name:JEYAKUMAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1093 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1703
Mailing Address - Country:US
Mailing Address - Phone:310-357-9793
Mailing Address - Fax:
Practice Address - Street 1:4623 160TH ST
Practice Address - Street 2:BASEMENT
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3632
Practice Address - Country:US
Practice Address - Phone:310-357-9793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA149541207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology