=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881991743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUNIL KUMAR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2011
-----------------------------------------------------
Last Update Date | 10/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 921 W BEACON ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39350-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-656-6116
-----------------------------------------------------
Fax | 601-656-5445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 WILL AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39350-9705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-584-1261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301092329
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 146N00000X
-----------------------------------------------------
Taxonomy Name | Basic Emergency Medical Technician
-----------------------------------------------------
License Number | 21671
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------