Active NPI
Suwannee Phumeetham, M.D.
- Pediatric Critical Care Medicine Physician
- Detroit, MI
National Provider Identifier
1336378355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Critical Care Medicine Physician
- License
- 4301094012
- Practice address
- 4201 Saint Antoine St
Detroit, MI 48201-2153 - Phone
- (313) 745-5147
- NPI assigned
- Jul 12, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Critical Care Medicine Physician | 2080P0203X | 4301094012 | MI | Primary |
Addresses
Primary practice location
4201 Saint Antoine St
Detroit, MI 48201-2153
Mailing address
4500 Cass Ave Apt 1022
Detroit, MI 48201-1861
Phone (313) 405-5173
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301094012 | MI | MD | Pediatric Critical Care Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1247356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247356800000",
"number": "1336378355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 CASS AVE APT 1022",
"city": "DETROIT",
"state": "MI",
"postal_code": "482011861",
"telephone_number": "313-405-5173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 SAINT ANTOINE ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012153",
"telephone_number": "313-745-5147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHUMEETHAM",
"first_name": "SUWANNEE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-12",
"last_updated": "2009-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0203X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": "MI",
"license": "4301094012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.