1811131246 NPI number — DR. SENTHUR JEYAMURUGAN THANGASAMY MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811131246 NPI number — DR. SENTHUR JEYAMURUGAN THANGASAMY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THANGASAMY
Provider First Name:
SENTHUR
Provider Middle Name:
JEYAMURUGAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811131246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611, NW 12 AVE, WW279
Provider Second Line Business Mailing Address:
WW 279 JACKSON MEMORIAL MEDICAL CENTER
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-858-8178
Provider Business Mailing Address Fax Number:
305-355-4051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 NW 12TH AVE
Provider Second Line Business Practice Location Address:
WW 279
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33136-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-585-8178
Provider Business Practice Location Address Fax Number:
305-355-4051
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  TRN 12309 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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