Healthcare Provider Details

I. General information

NPI: 1720019102
Provider Name (Legal Business Name): MICHAEL O SANUSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD SUITE 1E50
NEWARK DE
19718-2200
US

IV. Provider business mailing address

504 LADSON CT
DECATUR GA
30033-5379
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1980
  • Fax: 302-733-1986
Mailing address:
  • Phone: 470-493-4267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA54002
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number057666
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA54002
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number57666
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberC1-0028246
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: