MEDICARE: SURYA SANKARAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	4301032804	MI

General Provider Information

NPI Number	:	1144204793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SURYA SANKARAN M.D.

Provider Business Mailing Address
First Line	:	4449 FASHION SQUARE BLVD
Second Line	:
City	:	SAGINAW
State	:	MI
Zip	:	48603-5217
Country	:	US
Telephone Number	:	989-790-0007
Fax Number	:	989-790-7547

Provider Business Practice Location Address
First Line	:	651 M 55 E
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9238
Country	:	US
Telephone Number	:	989-362-8681
Fax Number	:	989-362-3321

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/08/2007

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