Provider Demographics
NPI:1033100540
Name:CAMISA, SUMNER
Entity Type:Individual
Prefix:DR
First Name:SUMNER
Middle Name:
Last Name:CAMISA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29829 TELEGRAPH ROAD
Mailing Address - Street 2:#100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034
Mailing Address - Country:US
Mailing Address - Phone:248-355-3033
Mailing Address - Fax:248-355-4936
Practice Address - Street 1:29829 TELEGRAPH ROAD
Practice Address - Street 2:#100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034
Practice Address - Country:US
Practice Address - Phone:248-355-3033
Practice Address - Fax:248-355-4936
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISC054195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICB0701OtherMEDICARE RAIL ROAD
MISC054195OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0F37202005Medicare PIN
F36676Medicare UPIN