Healthcare Provider Details

I. General information

NPI: 1629153192
Provider Name (Legal Business Name): MUTHIAH SUBRAMANIAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 HOSPITAL DR
EAST CHINA MI
48054-2200
US

IV. Provider business mailing address

2656 BYRD ST
DEARBORN MI
48124-4180
US

V. Phone/Fax

Practice location:
  • Phone: 810-329-4736
  • Fax:
Mailing address:
  • Phone: 313-271-4654
  • Fax: 313-271-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301061409
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: