Individual
DR. SHANKAR M SUNDARAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3085 WOODMAN DR STE 320, DAYTON, OH 45420-1171
(833) 828-0838
Mailing address
3085 WOODMAN DR STE 320, DAYTON, OH 45420-1164
(937) 795-1090
(937) 795-1145
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
35.140498
OH
208600000X
Surgery Physician
4301503585
MI
2086S0129X
Vascular Surgery Physician
Primary
35.140498
OH
2086S0129X
Vascular Surgery Physician
4301503585
MI
2086S0129X
Vascular Surgery Physician
DR.0069648
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H822401
MEDICARE PTAN
—
Enumeration date
05/08/2006
Last updated
11/08/2024
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