MEDICARE: DR. SATHYANARAYAN SUDHANTHAR MD

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	208000000X	Pediatrics Physician	4301084257	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1689685802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SATHYANARAYAN SUDHANTHAR MD

Provider Business Mailing Address
First Line	:	804 SERVICE RD STE A109B
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48824-7015
Country	:	US
Telephone Number	:	517-349-6560
Fax Number	:	517-349-5796

Provider Business Practice Location Address
First Line	:	1600 W GRAND RIVER AVE STE 2
Second Line	:
City	:	OKEMOS
State	:	MI
Zip	:	48864-2394
Country	:	US
Telephone Number	:	517-349-6560
Fax Number	:	517-349-5796

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	06/27/2023

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