Provider Demographics
NPI:1114554193
Name:RAJENDIRAN, SATHIYAKALA
Entity type:Individual
Prefix:
First Name:SATHIYAKALA
Middle Name:
Last Name:RAJENDIRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 LEAHY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5542
Mailing Address - Country:US
Mailing Address - Phone:231-740-6180
Mailing Address - Fax:231-672-8271
Practice Address - Street 1:1675 LEAHY ST STE 201
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5542
Practice Address - Country:US
Practice Address - Phone:231-740-6180
Practice Address - Fax:231-672-8271
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.49548207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program