Healthcare Provider Details

I. General information

NPI: 1073745493
Provider Name (Legal Business Name): SUMMIT GERIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MISSOURI RD STE 200
LEES SUMMIT MO
64086-4722
US

IV. Provider business mailing address

PO BOX 7612
OVERLAND PARK KS
66207-0612
US

V. Phone/Fax

Practice location:
  • Phone: 913-271-8676
  • Fax: 888-856-3199
Mailing address:
  • Phone: 913-271-8676
  • Fax: 888-856-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SHYAM K. AKKULUGARI
Title or Position: CEO/SOLE OWNER
Credential: MD
Phone: 913-271-8676