Basic Information
| Provider Information | |||||||||
| NPI: | 1730335662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JEYASINGH | ||||||||
| FirstName: | SUJA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 239 N. STATE ROAD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | OWOSSO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488679075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897294848 | ||||||||
| FaxNumber: | 9897294849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2008 | ||||||||
| LastUpdateDate: | 12/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301092327 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080G310660 | 01 | MI | MEDICARE PLUS BLUE PPO | OTHER | 080G310660 | 01 | MI | BLUE CARE NETWORK OF MICHIGAN | OTHER | 381908328-477 | 01 | MI | CARE SOURCE OF MICHIGAN | OTHER | 080G310660 | 01 | MI | BLUE PREFERRED PLUS BCBSM | OTHER | 1730335662 | 05 | MI | MEDICAID | 381908328 | 01 | MI | HEALTH NET/TRICARE | OTHER | 381908328 | 01 | MI | HCAP | OTHER | 080G310660 | 01 | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN TRADITIONAL | OTHER | 381908328 | 01 | MI | PRIORITY HEALTH | OTHER | 080G310660 | 01 | MI | BCBS OF MICHIGAN TRUST | OTHER | 1071207 | 01 | MI | MCLAREN HEALTH PLAN OF MI MHS, MHPM, MHPC | OTHER |