Healthcare Provider Details

I. General information

NPI: 1922117837
Provider Name (Legal Business Name): SUMNA E KURUVILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DESIARD PLAZA DR VA CLINIC
MONROE LA
71203-4955
US

IV. Provider business mailing address

2703 BRIERFIELD DR
MONROE LA
71201-3048
US

V. Phone/Fax

Practice location:
  • Phone: 318-345-5599
  • Fax:
Mailing address:
  • Phone: 318-388-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number11335R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: