Healthcare Provider Details

I. General information

NPI: 1689746224
Provider Name (Legal Business Name): SUNITHA SANTHAKUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST SUITE 8D
DETROIT MI
48201-2153
US

IV. Provider business mailing address

3800 WOODWARD AVE SUITE 600
DETROIT MI
48201-2061
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301078149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: