Provider Demographics
NPI:1508824525
Name:EBENEZER, SUDESH J (MD, EDM, FRCSC)
Entity Type:Individual
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First Name:SUDESH
Middle Name:J
Last Name:EBENEZER
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Gender:M
Credentials:MD, EDM, FRCSC
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Mailing Address - Street 1:4800 S SAGINAW ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2677
Mailing Address - Country:US
Mailing Address - Phone:810-732-8336
Mailing Address - Fax:810-963-1674
Practice Address - Street 1:4800 S SAGINAW ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2677
Practice Address - Country:US
Practice Address - Phone:810-732-8336
Practice Address - Fax:810-963-1674
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2014-12-10
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Provider Licenses
StateLicense IDTaxonomies
MI4301099586207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery