Provider Demographics
NPI:1851400543
Name:SUNDERMANN, MELISSA REBECCA (DO)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:REBECCA
Last Name:SUNDERMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR LBBY J2000
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:5505 S OLD US 23 STE 100
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-7524
Practice Address - Country:US
Practice Address - Phone:810-494-6885
Practice Address - Fax:810-494-6839
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC8122OtherMCARE
MI700M110750OtherBCBS
MI700M110750OtherBCBS
MION10070049Medicare ID - Type Unspecified