Provider Demographics
NPI:1447267539
Name:SUNIL K. DAS MD PC
Entity type:Organization
Organization Name:SUNIL K. DAS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-693-1808
Mailing Address - Street 1:256 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-2737
Mailing Address - Country:US
Mailing Address - Phone:248-693-1808
Mailing Address - Fax:248-693-5875
Practice Address - Street 1:256 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-2737
Practice Address - Country:US
Practice Address - Phone:248-693-1808
Practice Address - Fax:248-693-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1366423808OtherNPI
MI1377894Medicaid
MISD036953OtherSTATE ID
MI1366423808OtherNPI