Healthcare Provider Details

I. General information

NPI: 1750856902
Provider Name (Legal Business Name): SUKUMAR GUNDAPANENI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 NORTHWEST FWY STE 4201
CYPRESS TX
77433-5302
US

IV. Provider business mailing address

37000 GRAND RIVER AVE STE 310
FARMINGTON HILLS MI
48335-2868
US

V. Phone/Fax

Practice location:
  • Phone: 346-231-4628
  • Fax: 346-644-8144
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.246895
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV0409
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301504750
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberV0409
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: