Provider Demographics
NPI:1093796278
Name:PALANISWAMY, SUJINI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJINI
Middle Name:
Last Name:PALANISWAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30795 23 MILE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48047-5720
Mailing Address - Country:US
Mailing Address - Phone:586-421-3150
Mailing Address - Fax:586-421-3151
Practice Address - Street 1:30795 23 MILE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5720
Practice Address - Country:US
Practice Address - Phone:586-421-3150
Practice Address - Fax:586-421-3151
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4785757Medicaid
MIOEO6820Medicare PIN
MI4785757Medicaid