Individual
MR. KANDASAMY SURESH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
5521 HOUGHTEN DR, TROY, MI 48098-2908
(248) 301-0001
Mailing address
5521 HOUGHTEN DR, TROY, MI 48098-2908
(248) 301-0001
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
5501005288
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4539664
—
MI
Enumeration date
02/10/2008
Last updated
04/06/2020
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