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General NPI Number Information
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NPI Number | 1649606724
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Entity Type | Organization
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Legal Business Name | SUHASINI S MISTRY MD PLC
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 18420 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-3588
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Country | US
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Telephone | 734-425-5320
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Fax | 734-425-6212
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Provider Business Mailing Address
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Address Line | 18420 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-3588
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Country | US
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Telephone | 734-425-5320
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Fax | 734-425-6212
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DONNA DARST
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Credential |
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Telephone | 734-425-5320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 047972
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License Number State | MI
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