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NPI Code Detail

MEDICARE: SUNITA PREMKUMAR M.D.

MEDICARE: SUNITA PREMKUMAR M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician01061971AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01014115OTHERINRR MEDICARE PTAN
4P00331316OTHERINRR MEDICARE
5P01014115OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000487706OTHERINANTHEM

General Provider Information

NPI Number : 1861448722
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUNITA PREMKUMAR M.D.
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7910 E WASHINGTON ST STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-5563
Country : US
Telephone Number : 317-355-7171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 01/05/2026

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