1386852952 NPI number — SAIGEETHA UTHAMARAJAN MD

Table of content: SAIGEETHA UTHAMARAJAN MD (NPI 1386852952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386852952 NPI number — SAIGEETHA UTHAMARAJAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UTHAMARAJAN
Provider First Name:
SAIGEETHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1386852952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5730 EXECUTIVE DR STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-668-8650
Provider Business Mailing Address Fax Number:
248-668-8651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41100 FOX RUN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOVI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48377-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-668-8650
Provider Business Practice Location Address Fax Number:
248-668-8651
Provider Enumeration Date:
05/18/2007

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: 207RG0300X , with the licence number:  4301086760 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0806365741 . This is a "BCBS MI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1386852952 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 223695886 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04-39730 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".




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