Individual
GANESHKUMAR SHANMUGASUNDARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
28565 RYAN RD, WARREN, MI 48092-4176
(586) 486-5747
(586) 486-5836
Mailing address
28565 RYAN RD, WARREN, MI 48092-4176
(586) 486-5747
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501009846
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
65 0 EO 1640 0
BCBS
—
Enumeration date
03/13/2007
Last updated
01/19/2018
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