Provider Demographics
NPI:1669117669
Name:JAGANNATHAN, SUJAAY HARI (DO)
Entity type:Individual
Prefix:
First Name:SUJAAY HARI
Middle Name:
Last Name:JAGANNATHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:SUJAAY
Other - Middle Name:H
Other - Last Name:JAGANNATHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1215 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-1896
Mailing Address - Country:US
Mailing Address - Phone:517-432-9277
Mailing Address - Fax:517-432-9414
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1896
Practice Address - Country:US
Practice Address - Phone:517-432-9277
Practice Address - Fax:517-432-9414
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51510155642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology