Healthcare Provider Details

I. General information

NPI: 1003886151
Provider Name (Legal Business Name): RAMA V THYAGARAJAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 OAKWOOD BLVD STE 101 MEDICAL OFFICE BUILDING
DEARBORN MI
48124-4082
US

IV. Provider business mailing address

15500 LUNDY PKWY
DEARBORN MI
48126-2778
US

V. Phone/Fax

Practice location:
  • Phone: 313-436-2426
  • Fax: 313-436-2440
Mailing address:
  • Phone: 313-586-5011
  • Fax: 313-792-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301059512
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: