Healthcare Provider Details

I. General information

NPI: 1881991743
Provider Name (Legal Business Name): SUNIL KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W BEACON ST
PHILADELPHIA MS
39350-3229
US

IV. Provider business mailing address

201 WILL AVE
PHILADELPHIA MS
39350-9705
US

V. Phone/Fax

Practice location:
  • Phone: 601-656-6116
  • Fax: 601-656-5445
Mailing address:
  • Phone: 810-584-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301092329
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number21671
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: