MEDICARE: DR. VANITHA ISAAC JEYARAJ 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	207W00000X	Ophthalmology Physician	4301104104	MI
2	390200000X	Student in an Organized Health Care Education/Training Program	125-056436	IL

General Provider Information

NPI Number	:	1649409400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANITHA ISAAC JEYARAJ MD

Provider Business Mailing Address
First Line	:	3621 SOUTH STATE STREET
Second Line	:	700 KMS PLACE
City	:	ANN ARBOR
State	:	MI
Zip	:	48108
Country	:	US
Telephone Number	:	734-936-2047
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 WEST COMMERCE RD
Second Line	:
City	:	MILFORD
State	:	MI
Zip	:	48381-1892
Country	:	US
Telephone Number	:	248-684-7337
Fax Number	:	248-684-1286

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

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/31/2013

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