Healthcare Provider Details

I. General information

NPI: 1144617846
Provider Name (Legal Business Name): SUJATA PUTATUNDA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD STE 115
BINGHAM FARMS MI
48025-4302
US

IV. Provider business mailing address

31500 TELEGRAPH RD STE 115
BINGHAM FARMS MI
48025-4302
US

V. Phone/Fax

Practice location:
  • Phone: 248-621-9200
  • Fax: 248-621-9222
Mailing address:
  • Phone: 248-621-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4301107972
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301107972
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: