Provider Demographics
NPI:1750792388
Name:MOHAMMAD SUNBULLI MD PLLC
Entity type:Organization
Organization Name:MOHAMMAD SUNBULLI MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNBULLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-348-9926
Mailing Address - Street 1:25801 KELLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4467
Mailing Address - Country:US
Mailing Address - Phone:248-761-1035
Mailing Address - Fax:586-778-4952
Practice Address - Street 1:18263 E 10 MILE RD
Practice Address - Street 2:SUITE D
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5805
Practice Address - Country:US
Practice Address - Phone:586-778-4950
Practice Address - Fax:586-778-4952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1841571544OtherINDIVIDUAL NPI