Provider Demographics
NPI:1144259995
Name:JAYAKAR, SAROJA S (MD)
Entity type:Individual
Prefix:DR
First Name:SAROJA
Middle Name:S
Last Name:JAYAKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21610 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1812
Mailing Address - Country:US
Mailing Address - Phone:586-775-6010
Mailing Address - Fax:
Practice Address - Street 1:21610 E 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1812
Practice Address - Country:US
Practice Address - Phone:586-775-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISJ033040207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISJ033040OtherLICENCE NUMBER
MI1938182Medicaid
MI0605047351OtherBLUE CROSS/BLUE SHIELD
MI0605047351OtherBLUE CROSS/BLUE SHIELD
MIA77086Medicare UPIN
MIAJ7018559OtherDEA