Provider Demographics
NPI:1730335662
Name:JEYASINGH, SUJA (MD)
Entity type:Individual
Prefix:
First Name:SUJA
Middle Name:
Last Name:JEYASINGH
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 1:501 LAPEER
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:239 N. STATE ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9075
Practice Address - Country:US
Practice Address - Phone:989-729-4848
Practice Address - Fax:989-729-4849
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301092327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080G310660OtherMEDICARE PLUS BLUE PPO
MI080G310660OtherBLUE CARE NETWORK OF MICHIGAN
MI381908328-477OtherCARE SOURCE OF MICHIGAN
MI080G310660OtherBLUE PREFERRED PLUS BCBSM
MI1730335662Medicaid
MI381908328OtherHEALTH NET/TRICARE
MI381908328OtherHCAP
MI080G310660OtherBLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL
MI381908328OtherPRIORITY HEALTH
MI080G310660OtherBCBS OF MICHIGAN TRUST
MI1071207OtherMCLAREN HEALTH PLAN OF MI MHS, MHPM, MHPC
MI1730335662Medicaid