Provider Demographics
NPI:1912927849
Name:SUNIL K. KAUSHAL, M.D., P.C.
Entity type:Organization
Organization Name:SUNIL K. KAUSHAL, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAUSHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-733-3194
Mailing Address - Street 1:PO BOX 673695
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-0001
Mailing Address - Country:US
Mailing Address - Phone:810-230-0338
Mailing Address - Fax:810-230-0595
Practice Address - Street 1:1100 S LINDEN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3451
Practice Address - Country:US
Practice Address - Phone:810-733-3194
Practice Address - Fax:810-733-7519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052484207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3223583Medicaid
MIF36492Medicare UPIN
MI0253434Medicare ID - Type Unspecified