Provider Demographics
NPI:1841457454
Name:BANDARA, SURESHA CHANDANI (MD)
Entity type:Individual
Prefix:DR
First Name:SURESHA
Middle Name:CHANDANI
Last Name:BANDARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:R M SURESHA
Other - Middle Name:CHANDANI
Other - Last Name:RAJAGURU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3147 CHESTNUT RUN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1112
Mailing Address - Country:US
Mailing Address - Phone:248-892-0316
Mailing Address - Fax:
Practice Address - Street 1:3147 CHESTNUT RUN DR
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1112
Practice Address - Country:US
Practice Address - Phone:248-892-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084083207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease