Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 4301084666 | MI |
NPI | 1033173794 |
---|---|
Provider Name | Sugandhi Sridharan |
First Address | Kalamazoo, MI 49048-1639 |
Second Address | Kalamazoo, MI 49048-1639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4778322 | (05) | MI |
I38368 | (02) |