Provider Demographics
NPI:1811029614
Name:ARYA, INDIRA D (RD)
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:D
Last Name:ARYA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DETROIT HEALTH DEPT. - HERMAN KIEFER HEALTH COMPLEX
Mailing Address - Street 2:1151 TAYLOR STREET, ROOM 206C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1732
Mailing Address - Country:US
Mailing Address - Phone:313-876-0727
Mailing Address - Fax:313-876-4645
Practice Address - Street 1:DETROIT HEALTH DEPT. - HERMAN KIEFER HEALTH COMPLEX
Practice Address - Street 2:1151 TAYLOR STREET, ROOM 206C
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-1732
Practice Address - Country:US
Practice Address - Phone:313-876-0727
Practice Address - Fax:313-876-4645
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIR813195133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicare ID - Type Unspecified