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General NPI Number Information
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NPI Number | 1265938963
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Entity Type | Individual
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Provider Name | SAM SULTAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 08/31/2024
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Provider Practice Location Address
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Address Line | 443 SPRING ST STE 200
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-4494
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Country | US
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Telephone | 715-559-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 311 PROFESSIONAL PARK DR APT B
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City | GLASGOW
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State | KY
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Zip | 42141-3472
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Country | US
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Telephone | 715-559-8886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 59070
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01094004A
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License Number State | IN
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