Basic Information
| Provider Information | |||||||||
| NPI: | 1386852952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UTHAMARAJAN | ||||||||
| FirstName: | SAIGEETHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 EXECUTIVE DR STE 230 | ||||||||
| Address2: | |||||||||
| City: | CATONSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212281762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486688650 | ||||||||
| FaxNumber: | 2486688651 | ||||||||
| Practice Location | |||||||||
| Address1: | 41100 FOX RUN | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483774804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486688650 | ||||||||
| FaxNumber: | 2486688651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 02/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 4301086760 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 223695886 | 01 | TRICARE | OTHER | 0806365741 | 01 | BCBS MI | OTHER | 1386852952 | 05 | MI | MEDICAID | 04-39730 | 01 | EVERCARE | OTHER |