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General NPI Number Information
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NPI Number | 1710388251
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Entity Type | Organization
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Legal Business Name | SULTAN PLLC.
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 1019 GOVERNMENT ST STE. D
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-3860
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Country | US
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Telephone | 228-215-1004
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Fax | 228-238-3035
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Provider Business Mailing Address
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Address Line | 1206 IOLA RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-2819
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Country | US
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Telephone | 228-215-1004
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Fax | 228-238-3035
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Authorized Official
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Title or Position | PHYSICIAN / REGISTERED AGENT
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Name | SHAHJAHAN SULTAN
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Credential | M.D.
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Telephone | 228-215-1004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 21500
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License Number State | MS
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