Provider Demographics
NPI:1891063541
Name:VIBHASIRI, SASINEE (MD)
Entity Type:Individual
Prefix:
First Name:SASINEE
Middle Name:
Last Name:VIBHASIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 BROOKWOOD WALKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-1900
Mailing Address - Country:US
Mailing Address - Phone:248-644-6360
Mailing Address - Fax:248-644-6360
Practice Address - Street 1:732 BROOKWOOD WALKE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-1900
Practice Address - Country:US
Practice Address - Phone:248-644-6360
Practice Address - Fax:248-644-6360
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology