Provider Demographics
NPI:1285607184
Name:SUNDRAM, BHAVANI (MD)
Entity type:Individual
Prefix:
First Name:BHAVANI
Middle Name:
Last Name:SUNDRAM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446 - LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:1600 S CANTON CENTER RD
Practice Address - Street 2:STE 1200
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-1992
Practice Address - Country:US
Practice Address - Phone:734-398-7880
Practice Address - Fax:734-761-7318
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-12-31
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Provider Licenses
StateLicense IDTaxonomies
MI4301074607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H77117Medicare UPIN
MI0M32340Medicare PIN