Provider Demographics
NPI:1952302317
Name:TAMHANEY, SUNALI (MD)
Entity Type:Individual
Prefix:
First Name:SUNALI
Middle Name:
Last Name:TAMHANEY
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 1:4351 COMPTON WAY
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-2009
Mailing Address - Country:US
Mailing Address - Phone:248-790-6437
Mailing Address - Fax:248-676-0697
Practice Address - Street 1:700 REYNOLD SWEET PKWY
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1816
Practice Address - Country:US
Practice Address - Phone:248-790-6437
Practice Address - Fax:248-676-0697
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05190251OtherECFMG
MI4301068412OtherSTATE LICENSE
BT6677100OtherFEDERAL DEA
MIH17100Medicare UPIN