Provider Demographics
NPI:1275533093
Name:SUNDHEIMER, ALAN B (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:SUNDHEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 MONROE ST UNIT 207
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2735
Mailing Address - Country:US
Mailing Address - Phone:419-843-8150
Mailing Address - Fax:419-479-2579
Practice Address - Street 1:5700 MONROE ST UNIT 207
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2735
Practice Address - Country:US
Practice Address - Phone:419-843-8150
Practice Address - Fax:419-479-2579
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04-03323OtherUHC
OH110176017OtherRRMC
OH0637700OtherAETNA
OH0101357Medicaid
OH000000141271OtherANTHEM
OH02039OtherPARAMOUNT
OH0637700OtherAETNA
OH04-03323OtherUHC