Provider Demographics
NPI:1326312752
Name:SUNDAR, MIKE (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:SUNDAR
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-0936
Mailing Address - Country:US
Mailing Address - Phone:305-609-2233
Mailing Address - Fax:407-253-3993
Practice Address - Street 1:PO BOX 936
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-0936
Practice Address - Country:US
Practice Address - Phone:305-609-2233
Practice Address - Fax:407-253-3993
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26376207L00000X
FLME 26376207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine