Healthcare Provider Details

I. General information

NPI: 1801824768
Provider Name (Legal Business Name): SURESH ANNE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 NORKO DR
FLINT MI
48507-3021
US

IV. Provider business mailing address

5155 NORKO DR
FLINT MI
48507-3021
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-6700
  • Fax: 810-230-7764
Mailing address:
  • Phone: 810-720-6700
  • Fax: 810-230-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301039021
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301070273
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number4301052842
License Number StateMI

VIII. Authorized Official

Name: SURESH ANNE
Title or Position: PRESIDENT
Credential: MD
Phone: 810-720-6700