MEDICARE: DR. SURESHA CHANDANI BANDARA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	4301084083	MI

General Provider Information

NPI Number	:	1841457454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESHA CHANDANI BANDARA M.D.

Provider Business Mailing Address
First Line	:	3147 CHESTNUT RUN DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1112
Country	:	US
Telephone Number	:	248-892-0316
Fax Number	:

Provider Business Practice Location Address
First Line	:	3147 CHESTNUT RUN DR
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-1112
Country	:	US
Telephone Number	:	248-892-0316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	01/10/2024

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