Healthcare Provider Details

I. General information

NPI: 1720002900
Provider Name (Legal Business Name): SUDHA PREMANAND KAMATH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 N MOPAC EXPY STE 304
AUSTIN TX
78759-8323
US

IV. Provider business mailing address

8400 N MOPAC EXPY STE 304
AUSTIN TX
78759-8323
US

V. Phone/Fax

Practice location:
  • Phone: 512-772-6862
  • Fax: 512-379-0259
Mailing address:
  • Phone: 512-722-6862
  • Fax: 512-379-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV4684
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberV4684
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: