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General NPI Number Information
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NPI Number | 1336397322
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Entity Type | Organization
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Legal Business Name | CMM SUNDARAM MD SC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | 2600 N MAYFAIR RD SUITE 670
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City | WAUWATOSA
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State | WI
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Zip | 53226-1309
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Country | US
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Telephone | 414-933-9851
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 N MAYFAIR RD SUITE 670
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City | WAUWATOSA
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State | WI
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Zip | 53226-1309
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Country | US
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Telephone | 414-933-9851
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CMM SUNDARAM
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Credential | MD
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Telephone | 414-933-9851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 21941
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 21941
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 21941
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License Number State | WI
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