Healthcare Provider Details

I. General information

NPI: 1699087296
Provider Name (Legal Business Name): ANUPAM SULE M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-6281
  • Fax: 888-993-4445
Mailing address:
  • Phone: 248-858-6281
  • Fax: 888-993-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301096035
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number4301096035
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: