Provider Demographics
NPI:1174534283
Name:KASHYAP, SUMAN GAURESH (MD)
Entity type:Individual
Prefix:DR
First Name:SUMAN
Middle Name:GAURESH
Last Name:KASHYAP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:OLIN HEALTH CENTER
Mailing Address - Street 2:EAST CIRCLE DRIVE
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1037
Mailing Address - Country:US
Mailing Address - Phone:517-884-6546
Mailing Address - Fax:
Practice Address - Street 1:EAST CIRCLE DR
Practice Address - Street 2:OLIN HEALTH CTR
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:517-355-4510
Practice Address - Fax:517-432-9528
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301042427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1413210Medicaid
MIF41407Medicare UPIN
MIC36019135Medicare PIN