=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568109585
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSMITA UNNI MD, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2022
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 WATKINS RD
-----------------------------------------------------
City | BATTLE CREEK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49015-8604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-245-5430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 JOHN STREET BOX 42
-----------------------------------------------------
City | KALAMZOO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301513250
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------