Individual
LEELA SURULINARAYANASAMI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD PC
Contact information
Practice address
4811 VENOY RD, WAYNE, MI 48184-2675
(734) 721-0707
Mailing address
1292 HIDDEN LAKE DR, BLOOMFIELD HILLS, MI 48302-1955
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
4301032052
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
382329404
TAX ID
MI
Enumeration date
02/17/2006
Last updated
07/21/2011
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