Healthcare Provider Details

I. General information

NPI: 1689685802
Provider Name (Legal Business Name): SATHYANARAYAN SUDHANTHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W GRAND RIVER AVE STE 2
OKEMOS MI
48864-2394
US

IV. Provider business mailing address

804 SERVICE RD STE A109B
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-349-6560
  • Fax: 517-349-5796
Mailing address:
  • Phone: 517-349-6560
  • Fax: 517-349-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301084257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: