Healthcare Provider Details

I. General information

NPI: 1205996162
Provider Name (Legal Business Name): SUMATHI PARVATANENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 S STEPHENSON AVE SUITE 210
IRON MOUNTAIN MI
49801-3639
US

IV. Provider business mailing address

1711 S STEPHENSON AVE SUITE 210
IRON MOUNTAIN MI
49801-3639
US

V. Phone/Fax

Practice location:
  • Phone: 906-776-5800
  • Fax:
Mailing address:
  • Phone: 906-776-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301084683
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: