Individual
KUMUDINIE C FONSEKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
21327 HARPER AVENUE, SUITE D, ST CLAIR SHORES, MI 48080
(586) 772-2300
(586) 772-7111
Mailing address
21327 HARPER AVENUE, SUITE D, ST CLAIR SHORES, MI 48080
(586) 772-2300
(586) 772-7111
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301049484
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1943271
—
MI
Enumeration date
08/30/2006
Last updated
10/22/2012
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