Provider Demographics
NPI:1811401045
Name:SUPRA VASCULAR ASSOCIATES PLC
Entity Type:Organization
Organization Name:SUPRA VASCULAR ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:UMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-389-0648
Mailing Address - Street 1:16507 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2503
Mailing Address - Country:US
Mailing Address - Phone:313-389-0648
Mailing Address - Fax:313-389-3510
Practice Address - Street 1:16507 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2503
Practice Address - Country:US
Practice Address - Phone:313-389-0648
Practice Address - Fax:313-389-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty