Healthcare Provider Details

I. General information

NPI: 1982706974
Provider Name (Legal Business Name): SUNIL KUMAR GUJRATHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WAGON TRAIL AVE
LAS VEGAS NV
89118-4426
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 202
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 702-942-4123
  • Fax: 702-942-4124
Mailing address:
  • Phone: 877-406-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA11924600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number235600
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number13205
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC191344
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number235600
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME164921
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-23935-0
License Number StateHI
# 8
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number70805
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13205
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: