Provider Demographics
NPI:1275860314
Name:PACHIYANNAKIS, THALIA RAYA
Entity type:Individual
Prefix:DR
First Name:THALIA
Middle Name:RAYA
Last Name:PACHIYANNAKIS
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 1:52444 HICKORY RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7433
Mailing Address - Country:US
Mailing Address - Phone:810-282-1405
Mailing Address - Fax:
Practice Address - Street 1:1545 CASSOPOLIS ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3128
Practice Address - Country:US
Practice Address - Phone:574-584-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094455207V00000X
IN01072322A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01072322AOtherIN LICENSE
IN1275860314OtherNPI