Provider Demographics
NPI:1255447215
Name:SOOD, USHA R (MD)
Entity type:Individual
Prefix:MRS
First Name:USHA
Middle Name:R
Last Name:SOOD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:18285 TEN MILE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066
Mailing Address - Country:US
Mailing Address - Phone:586-776-7546
Mailing Address - Fax:586-447-4910
Practice Address - Street 1:18285 TEN MILE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066
Practice Address - Country:US
Practice Address - Phone:586-776-7546
Practice Address - Fax:586-447-4910
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301039212207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B45777Medicare UPIN
05025762071Medicare ID - Type Unspecified