Provider Demographics
NPI:1588445787
Name:SURESHA BANDARA MDPC
Entity type:Organization
Organization Name:SURESHA BANDARA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SURESHA
Authorized Official - Middle Name:CHANDANI
Authorized Official - Last Name:BANDARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-892-0316
Mailing Address - Street 1:3147 CHESTNUT RUN DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-12
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty