Provider Demographics
NPI:1700801602
Name:THIRAVIAM PILLAI, RAJESH (MD)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:THIRAVIAM PILLAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RAJESH
Other - Middle Name:T
Other - Last Name:PILLAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1635 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-8813
Mailing Address - Country:US
Mailing Address - Phone:602-544-2273
Mailing Address - Fax:602-544-3017
Practice Address - Street 1:1635 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8813
Practice Address - Country:US
Practice Address - Phone:602-544-2273
Practice Address - Fax:602-544-3017
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ797037Medicaid
AZZ75116Medicare PIN
AZ797037Medicaid