Provider Demographics
NPI:1518314442
Name:CHITNIS, SUNIL TRIMBAK
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:TRIMBAK
Last Name:CHITNIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G3064 MILLER RD APT 706
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1342
Mailing Address - Country:US
Mailing Address - Phone:226-400-3157
Mailing Address - Fax:
Practice Address - Street 1:1810 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48506-3780
Practice Address - Country:US
Practice Address - Phone:810-232-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302034448OtherMICHIGAN STATE BOARD OF PHARMACY - PHARMACIST - 183500000X