Provider Demographics
NPI:1619913902
Name:SUNDAR, SATISH (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:
Last Name:SUNDAR
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 1:7210 N MAIN ST
Mailing Address - Street 2:STE 205
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1575
Mailing Address - Country:US
Mailing Address - Phone:248-625-9755
Mailing Address - Fax:248-620-9334
Practice Address - Street 1:7210 N MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-1575
Practice Address - Country:US
Practice Address - Phone:248-625-9755
Practice Address - Fax:248-620-9334
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISS056128208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F78383Medicare UPIN
MIM95030001Medicare ID - Type Unspecified