Healthcare Provider Details

I. General information

NPI: 1053645960
Provider Name (Legal Business Name): VARUN SUNDARAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVENUE LAKESIDE BUILDING, 3RD FLOOR UNIVERSITY HOSPITAL CASE MEDICAL CENTER
CLEVELAND OH
44106-5912
US

IV. Provider business mailing address

1872 COLTMAN RD
CLEVELAND OH
44106-1916
US

V. Phone/Fax

Practice location:
  • Phone: 216-577-1261
  • Fax:
Mailing address:
  • Phone: 216-399-3385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNA
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.127822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: