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General NPI Number Information
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NPI Number | 1326129453
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Entity Type | Individual
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Provider Name | SURESH K MUKHERJI MD
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 804 SERVICE RD D100
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City | EAST LANSING
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State | MI
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Zip | 48824-7015
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Country | US
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Telephone | 517-353-5053
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Fax | 517-432-4394
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Provider Business Mailing Address
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Address Line | 804 SERVICE RD ROOM A201
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City | EAST LANSING
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State | MI
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Zip | 48824-7015
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Country | US
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Telephone | 517-884-2976
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Fax | 517-432-3928
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 4301077390
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | M-2189
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License Number State | GU
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 4301077390
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License Number State | MI
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