Organization
CMM SUNDARAM MD SC
Active
Organization
CMM SUNDARAM MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CMM SUNDARAM MD (PRESIDENT)
(414) 933-9851
Entity
Organization
Contact information
Practice address
2600 N MAYFAIR RD, SUITE 670, WAUWATOSA, WI 53226-1309
(414) 933-9851
Mailing address
2600 N MAYFAIR RD, SUITE 670, WAUWATOSA, WI 53226-1309
(414) 933-9851
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
21941
WI
207RG0100X
Gastroenterology Physician
Primary
21941
WI
207RR0500X
Rheumatology Physician
21941
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00146365
MEDICARE ID
WI
05
—
30317000
—
WI
Enumeration date
09/03/2008
Last updated
09/03/2008
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