Provider Demographics
NPI:1942490453
Name:THARAN, SUMI
Entity Type:Individual
Prefix:
First Name:SUMI
Middle Name:
Last Name:THARAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2191 FOX HILL DR APT 6
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5226
Mailing Address - Country:US
Mailing Address - Phone:718-775-5714
Mailing Address - Fax:
Practice Address - Street 1:ONE HURLEY PLAZA
Practice Address - Street 2:HURLEY MEDICAL CENTER
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-972-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088216174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist