MEDICARE: SANTHAKUMAR NEUROLOGY ASSOCIATES, PC

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	261Q00000X	Clinic/Center	4301078149	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0F36135053	OTHER	MI	MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164973095
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTHAKUMAR NEUROLOGY ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	1423 WALTON BLVD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1775
Country	:	US
Telephone Number	:	248-495-7417
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 WALTON BLVD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1775
Country	:	US
Telephone Number	:	248-495-7417
Fax Number	:

Authorized Official
Title or Position	:	NEUROLOGIST
Name	:	DR. SUNITHA SANTHAKUMAR
Credential	:	M.D
Telephone Number	:	248-495-7417

Provider Enumeration Date	:	10/15/2016
Last Update Date	:	10/15/2016

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