MEDICARE: DR. ARASI THANGAVELU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	051771	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	930123503	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	52008844-003	OTHER	GA	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	336307	OTHER	GA	WELLCARE
5	52008844002	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1548255177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARASI THANGAVELU MD

Provider Business Mailing Address
First Line	:	1400 VILLAGE SQUARE BLVD STE 3-258
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1250
Country	:	US
Telephone Number	:	850-518-4325
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 VILLAGE SQUARE BLVD STE 3-258
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1250
Country	:	US
Telephone Number	:	850-545-9376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	04/27/2021

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