MEDICARE: INDU SUNDARARAJAN 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	069973	GA

General Provider Information

NPI Number	:	1477874469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDU SUNDARARAJAN M.D

Provider Business Mailing Address
First Line	:	3495 PIEDMONT RD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-364-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 LAKE HEARN DR STE 250
Second Line	:	KAISER PERMANENTE SANDY SPRINGS MEDICAL OFFICE
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-1523
Country	:	US
Telephone Number	:	404-845-4500
Fax Number	:

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

Provider Enumeration Date	:	06/14/2010
Last Update Date	:	01/13/2022

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