Provider Demographics
NPI:1497722573
Name:SINGAL, SUDARSHAN K (MD)
Entity Type:Individual
Prefix:
First Name:SUDARSHAN
Middle Name:K
Last Name:SINGAL
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 1:2070 BIDDLE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-4080
Mailing Address - Country:US
Mailing Address - Phone:734-283-4460
Mailing Address - Fax:734-283-6560
Practice Address - Street 1:2070 BIDDLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4080
Practice Address - Country:US
Practice Address - Phone:734-283-4460
Practice Address - Fax:734-283-6560
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032938207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1298075Medicaid
110129165OtherRAILROAD MEDICARE
1108264381OtherBCBSM
16438OtherM-CARE
16438OtherM-CARE
B44342Medicare UPIN
MIM18780001Medicare PIN