Provider Demographics
NPI:1144238742
Name:SUBRAMANIAN, BANUMATHY (MD)
Entity Type:Individual
Prefix:
First Name:BANUMATHY
Middle Name:
Last Name:SUBRAMANIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20225 E 9 MILE RD
Mailing Address - Street 2:STE A
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1700
Mailing Address - Country:US
Mailing Address - Phone:586-573-9090
Mailing Address - Fax:586-573-2128
Practice Address - Street 1:29703 HOOVER RD
Practice Address - Street 2:STEB
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-8901
Practice Address - Country:US
Practice Address - Phone:586-573-9090
Practice Address - Fax:586-573-2128
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301076114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics