Provider Demographics
NPI:1124044797
Name:KUMAR, SATHISH SUBRAMANIAN (MD)
Entity Type:Individual
Prefix:
First Name:SATHISH
Middle Name:SUBRAMANIAN
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUBRAMANIAN
Other - Middle Name:
Other - Last Name:SATHISHKUMAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3621 SOUTH STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DR
Practice Address - Street 2:1H247 UNIVERSITY HOSPITAL
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5048
Practice Address - Country:US
Practice Address - Phone:734-936-4280
Practice Address - Fax:734-936-9091
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087052207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4859108Medicaid
MI4859108Medicaid
MIOH16010571Medicare ID - Type Unspecified