MEDICARE: DR. SUSHRUT SUNIL DHARMADHIKARI 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	207T00000X	Neurological Surgery Physician	E-10455	AR
2	2084N0400X	Neurology Physician	MD-61582983	WA
3	2084N0400X	Neurology Physician	C176123	CA
4	2084N0400X	Neurology Physician	01089709A	IN
5	2084N0400X	Neurology Physician	E-10455	AR
6	2084V0102X	Vascular Neurology Physician	T5297	TX
7	2084V0102X	Vascular Neurology Physician	E-10455	AR
8	2085N0700X	Neuroradiology Physician	E-10455	AR
9	2085N0700X	Neuroradiology Physician	DR.0067274	CO
10	2085N0700X	Neuroradiology Physician	T5297	TX
11	2084N0400X	Neurology Physician	T5297	TX

General Provider Information

NPI Number	:	1831496942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSHRUT SUNIL DHARMADHIKARI MD

Provider Business Mailing Address
First Line	:	5340 BENTLEY RD APT 104
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-2186
Country	:	US
Telephone Number	:	330-503-8301
Fax Number	:

Provider Business Practice Location Address
First Line	:	21212 NORTHWEST FWY STE 645A
Second Line	:
City	:	CYPRESS
State	:	TX
Zip	:	77429-6070
Country	:	US
Telephone Number	:	281-894-5310
Fax Number	:	281-894-5313

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

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	07/17/2024

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