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Individual
SRIKANTH THYAGARAJ JYOTHINAGARAM
Active
Individual
SRIKANTH THYAGARAJ JYOTHINAGARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301089867
MI
207R00000X
Internal Medicine Physician
Primary
Q2456
TX
208M00000X
Hospitalist Physician
4301089867
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306057856
—
MI
05
—
5186424
—
MI
01
—
700E012740
BCBSM GROUP NUMBER
MI
01
—
SJ089867
MICHIGAN LICENSE
MI
Enumeration date
05/25/2007
Last updated
08/27/2015
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