Provider Demographics
NPI:1437219540
Name:SUNDARA, BILUGALI (MD)
Entity Type:Individual
Prefix:MR
First Name:BILUGALI
Middle Name:
Last Name:SUNDARA
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 1:2110 16TH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7609
Mailing Address - Country:US
Mailing Address - Phone:989-892-2517
Mailing Address - Fax:989-892-4860
Practice Address - Street 1:2110 16TH ST
Practice Address - Street 2:STE 4
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7609
Practice Address - Country:US
Practice Address - Phone:989-892-2517
Practice Address - Fax:989-892-4860
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBS038946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821090Medicaid
MI3505922OtherHEALTH PLUS
MI350Z96028OtherBLUE CROSS BLUE SHIELD