Healthcare Provider Details

I. General information

NPI: 1730335662
Provider Name (Legal Business Name): SUJA JEYASINGH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 N. STATE ROAD SUITE A
OWOSSO MI
48867-9075
US

IV. Provider business mailing address

501 LAPEER
SAGINAW MI
48607-1208
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-4848
  • Fax: 989-729-4849
Mailing address:
  • Phone: 989-759-6464
  • Fax: 989-399-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301092327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: