Healthcare Provider Details

I. General information

NPI: 1932752623
Provider Name (Legal Business Name): SUKHMANI BOPARAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 02/09/2025
Certification Date: 02/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INTERNAL MEDICINE 1501 KINGS HIGHWAY
SHREVEPORT LA
71130-3932
US

IV. Provider business mailing address

INTERNAL MEDICINE 1501 KINGS HIGHWAY
SHREVEPORT LA
71130-3932
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-0436
  • Fax:
Mailing address:
  • Phone: 318-626-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number17033
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number17033
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: