Provider Demographics
NPI:1093091316
Name:SUDHAKARAN JEGADEESH INC
Entity Type:Organization
Organization Name:SUDHAKARAN JEGADEESH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUDHAKARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEGADEESH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:248-552-1012
Mailing Address - Street 1:17418 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2951
Mailing Address - Country:US
Mailing Address - Phone:248-552-1012
Mailing Address - Fax:248-552-0657
Practice Address - Street 1:17418 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2951
Practice Address - Country:US
Practice Address - Phone:248-552-1012
Practice Address - Fax:248-552-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010071562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty