Provider Demographics
NPI:1255426326
Name:LOWHIM, SUGANDHA (MD)
Entity type:Individual
Prefix:
First Name:SUGANDHA
Middle Name:
Last Name:LOWHIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-351-8377
Mailing Address - Fax:517-351-1738
Practice Address - Street 1:2700 BURCHAM DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-3898
Practice Address - Country:US
Practice Address - Phone:517-351-8377
Practice Address - Fax:517-351-1738
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062040207R00000X, 207RG0300X
MI2301062040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI773308869Medicaid
MI1255426326Medicaid
MIC36051032Medicare ID - Type UnspecifiedPERSONAL PROV ID