Basic Information
| Provider Information | |||||||||
| NPI: | 1790970317 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUBBANA G. MUTHUSWAMI, MD P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2603 ELECTRIC AVE | ||||||||
| Address2: | SUITE1 | ||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480606588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109875252 | ||||||||
| FaxNumber: | 8109872120 | ||||||||
| Practice Location | |||||||||
| Address1: | 2603 ELECTRIC AVE | ||||||||
| Address2: | SUITE1 | ||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480606588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109875252 | ||||||||
| FaxNumber: | 8109872120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2007 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | MUTHUSWAMI | ||||||||
| AuthorizedOfficialFirstName: | SUBBANA | ||||||||
| AuthorizedOfficialMiddleName: | GOUNDER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8109875252 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 4301033903 | MI | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.