MEDICARE: THIRUMALAI SUNDARA-RAJAN PA

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	363A00000X	Physician Assistant	50002154	OH

General Provider Information

NPI Number	:	1356411102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THIRUMALAI SUNDARA-RAJAN PA

Provider Business Mailing Address
First Line	:	22175 RYE RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-3037
Country	:	US
Telephone Number	:	216-295-0047
Fax Number	:

Provider Business Practice Location Address
First Line	:	22175 RYE RD
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-3037
Country	:	US
Telephone Number	:	216-295-0047
Fax Number	:

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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