Healthcare Provider Details

I. General information

NPI: 1376597369
Provider Name (Legal Business Name): SUNIL K KAUSHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S LINDEN RD SUITE 2
FLINT MI
48532-3451
US

IV. Provider business mailing address

P O BOX 673695
DETROIT MI
48267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-3194
  • Fax: 810-733-7519
Mailing address:
  • Phone: 810-230-0338
  • Fax: 810-230-0595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number4301052484
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: