Provider Demographics
NPI:1215943600
Name:NATESAN, SUGANTHINI KRISHNAN (MD)
Entity type:Individual
Prefix:DR
First Name:SUGANTHINI
Middle Name:KRISHNAN
Last Name:NATESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUGANTHINI
Other - Middle Name:KRISHNAN
Other - Last Name:NATESAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3990 JOHN R ST
Mailing Address - Street 2:5 HUDSON, DIV OF INF DISEASES
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2018
Mailing Address - Country:US
Mailing Address - Phone:248-624-0744
Mailing Address - Fax:313-993-0302
Practice Address - Street 1:4646 JOHN R ROAD
Practice Address - Street 2:JOHN D BINGELL VA MEDICAL CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-577-7858
Practice Address - Fax:313-577-1858
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071707207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease