Healthcare Provider Details

I. General information

NPI: 1396364550
Provider Name (Legal Business Name): NIKITA SUMZIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 N BROAD STREET EXT
GROVE CITY PA
16127-4603
US

IV. Provider business mailing address

1700 UNIVERSITY AVE W
SAINT PAUL MN
55104-3727
US

V. Phone/Fax

Practice location:
  • Phone: 724-450-7246
  • Fax: 724-450-7247
Mailing address:
  • Phone: 612-672-6740
  • Fax: 612-884-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number81029
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: