Provider Demographics
NPI:1902089295
Name:SADHISHKUMAR, POOMATHI (MD;)
Entity Type:Individual
Prefix:DR
First Name:POOMATHI
Middle Name:
Last Name:SADHISHKUMAR
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 1:1515 LAKE LANSING RD STE C3
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3752
Mailing Address - Country:US
Mailing Address - Phone:517-482-9582
Mailing Address - Fax:
Practice Address - Street 1:1515 LAKE LANSING RD STE C2
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3752
Practice Address - Country:US
Practice Address - Phone:517-482-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083900208000000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC37626067Medicare PIN