Doctor Name: | DR. MOHAMMAD SUNBULLI |
NPI Number: | 1841571544 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D |
License Number: | 4301080838 |
Business Practice Address: | 18263 E 10 Mile Rd Suite D Roseville, MI - 480665805 |
Business Phone Number: | 3133489926 |
Business Fax Number: | |
Mailing Address: | Po Box 251752, WEST BLOOMFIELD |
State: | MI |
Postal Code: | 483251752 |
Phone Number: | 3133489926 |
Fax Number: | |
NPI Enumeration Date: | 09/08/2011 |
NPI Last Update Date: | 01/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 4301080838 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |