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General NPI Number Information
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NPI Number | 1861723215
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Entity Type | Individual
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Provider Name | SUSHMA GUNTURU MD
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Gender | Female
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 2640 W POINT RD ATTN: CREDENTIAL SPECIALIST
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City | GREEN BAY
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State | WI
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Zip | 54304-1344
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Country | US
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Telephone | 920-490-3790
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Fax | 920-490-3858
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Provider Business Mailing Address
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Address Line | PO BOX 365 ATTN: CREDENTIALING SPECIALIST
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City | ONEIDA
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State | WI
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Zip | 54155-0365
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Country | US
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Telephone | 920-869-2711
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 4301103402
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 697-320
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License Number State | WI
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