Healthcare Provider Details

I. General information

NPI: 1487692190
Provider Name (Legal Business Name): SURYA N SANKARAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 M 55 E
TAWAS CITY MI
48763-9238
US

IV. Provider business mailing address

4449 FASHION SQUARE BLVD
SAGINAW MI
48603-5217
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-8681
  • Fax:
Mailing address:
  • Phone: 989-790-0007
  • Fax: 989-790-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SURYA SANKARAN
Title or Position: OWNER
Credential: M.D.
Phone: 989-362-8681