Basic Information
| Provider Information | |||||||||
| NPI: | 1275533093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUNDHEIMER | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 MONROE ST UNIT 207 | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198438150 | ||||||||
| FaxNumber: | 4194792579 | ||||||||
| Practice Location | |||||||||
| Address1: | 5700 MONROE ST UNIT 207 | ||||||||
| Address2: | |||||||||
| City: | SYLVANIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435602735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198438150 | ||||||||
| FaxNumber: | 4194792579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35040004 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04-03323 | 01 | OH | UHC | OTHER | 110176017 | 01 | OH | RRMC | OTHER | 0637700 | 01 | OH | AETNA | OTHER | 0101357 | 05 | OH | MEDICAID | 000000141271 | 01 | OH | ANTHEM | OTHER | 02039 | 01 | OH | PARAMOUNT | OTHER |