Healthcare Provider Details

I. General information

NPI: 1063604874
Provider Name (Legal Business Name): ASHAKIRAN J. SUNKU, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 08/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N GRAND AVE SUITE: 110
PUEBLO CO
81003-2700
US

IV. Provider business mailing address

1600 N GRAND AVE SUITE: 110
PUEBLO CO
81003-2700
US

V. Phone/Fax

Practice location:
  • Phone: 719-546-9500
  • Fax: 719-546-9503
Mailing address:
  • Phone: 719-546-9500
  • Fax: 719-546-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHAKIRAN J SUNKU
Title or Position: OWNER
Credential: M.D.
Phone: 719-546-9500