Provider Demographics
NPI:1609213032
Name:MICHIGAN ACADEMIC HOSPITALIST GROUP
Entity Type:Organization
Organization Name:MICHIGAN ACADEMIC HOSPITALIST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUBBURMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-744-5010
Mailing Address - Street 1:33742 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3358
Mailing Address - Country:US
Mailing Address - Phone:248-893-6610
Mailing Address - Fax:248-893-6746
Practice Address - Street 1:33742 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3358
Practice Address - Country:US
Practice Address - Phone:248-893-6610
Practice Address - Fax:248-893-6746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty