Provider Demographics
NPI:1912218793
Name:AMEDA, SRUJAN (MD)
Entity Type:Individual
Prefix:
First Name:SRUJAN
Middle Name:
Last Name:AMEDA
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:B301 CLINICAL CTR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1313
Mailing Address - Country:US
Mailing Address - Phone:517-353-5100
Mailing Address - Fax:517-432-2759
Practice Address - Street 1:138 SERVICE RD
Practice Address - Street 2:A225 CLINICAL CENTER
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1376
Practice Address - Country:US
Practice Address - Phone:517-353-4941
Practice Address - Fax:517-432-3145
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301096276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine