Healthcare Provider Details

I. General information

NPI: 1043290992
Provider Name (Legal Business Name): UMASANKARI SUNDARAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7831 CHICAGO COURT
OMAHA NE
68114-3654
US

IV. Provider business mailing address

PO BOX 3755
OMAHA NE
68103-0755
US

V. Phone/Fax

Practice location:
  • Phone: 402-561-2740
  • Fax: 402-561-2738
Mailing address:
  • Phone: 402-354-2100
  • Fax: 402-354-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number27974
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: