Provider Demographics
NPI:1225584550
Name:JOSEPH, SUMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMITA
Middle Name:
Last Name:JOSEPH
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 1:1156 HEATHERWOODE RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2336
Mailing Address - Country:US
Mailing Address - Phone:810-449-7547
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE HOSPITAL
Practice Address - Street 2:16001 W. 9 MILE RD
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075
Practice Address - Country:US
Practice Address - Phone:248-849-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ670002085R0202X
MA2876952085R0202X
IL0361617642085R0202X
FLME1580222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301110830OtherMEDICAL LICENSE