Provider Demographics
NPI:1336101443
Name:ANNE, SURESH (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:ANNE
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 1:5155 NORKO DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3021
Mailing Address - Country:US
Mailing Address - Phone:810-720-6700
Mailing Address - Fax:810-230-7764
Practice Address - Street 1:5155 NORKO DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3021
Practice Address - Country:US
Practice Address - Phone:810-720-6700
Practice Address - Fax:810-230-7764
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052842207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2943051Medicaid
MI2943051Medicaid
F50769Medicare UPIN
MIMI2311Medicare PIN