Individual
KRISHNAPILLAI THAVARAJAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16407 SOUTHFIELD RD, STE A, ALLEN PARK, MI 48101-2571
(313) 271-3000
(313) 271-3003
Mailing address
PO BOX 77000 DEPT 771255, DETROIT, MI 48277-2000
(313) 271-3000
(313) 271-3003
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
A301033660
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103192
GREAT LAKES HEALTH PLAN
MI
01
—
108137
CARE CHOICES
MI
01
—
110058813C30371
TRAVELERS MEDICARE
MI
01
—
110Q26434
BLUE CROSS BLUE SHIELD
MI
01
—
204980
FEDERAL BLACK LUNG
MI
05
—
2801412
—
MI
01
—
4098
CAPE HEALTH PLAN
MI
01
—
4572248
AETNA
MI
01
—
C2630
M-CARE
MI
01
—
G02484
BLUECARE NETWORK
MI
01
—
P2834
BLUECARE NETWORK
MI
Enumeration date
08/10/2005
Last updated
01/30/2019
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