MEDICARE: MR. SUBROTO KUNDU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	CV2200139	IN
2	2084N0400X	Neurology Physician	A46139	CA
3	2084N0400X	Neurology Physician	45396	TN

General Provider Information

NPI Number	:	1063426302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SUBROTO KUNDU M.D.

Provider Business Mailing Address
First Line	:	3555 KEITH ST NW
Second Line	:	SUITE 211
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-790-1529
Fax Number	:	423-790-1589

Provider Business Practice Location Address
First Line	:	3555 KEITH ST NW
Second Line	:	SUITE 211
City	:	CLEVELAND
State	:	TN
Zip	:	37312-4375
Country	:	US
Telephone Number	:	423-790-1529
Fax Number	:	423-790-1589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	10/15/2022

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