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General NPI Number Information
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NPI Number | 1609835115
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Entity Type | Individual
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Provider Name | MICHAEL P SUMIDA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 03/01/2010
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Provider Practice Location Address
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Address Line | 719 COOK DR STE 109
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City | ATHENS
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State | TN
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Zip | 37303-3495
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Country | US
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Telephone | 423-745-2344
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Fax | 423-745-2314
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Provider Business Mailing Address
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Address Line | PO BOX 667
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City | ETOWAH
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State | TN
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Zip | 37331-0667
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Country | US
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Telephone | 423-745-2344
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Fax | 423-745-2314
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD27304
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License Number State | TN
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