MEDICARE: MR. RAMEGOWDA SUDHEENDRA MD

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	207Q00000X	Family Medicine Physician	MD36132	TN
2	207R00000X	Internal Medicine Physician	MD36132	TN

General Provider Information

NPI Number	:	1215926886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAMEGOWDA SUDHEENDRA MD

Provider Business Mailing Address
First Line	:	1124 HWY 52 W BY PASS
Second Line	:
City	:	WESTMORELAND
State	:	TN
Zip	:	37186
Country	:	US
Telephone Number	:	615-644-4203
Fax Number	:	615-644-4228

Provider Business Practice Location Address
First Line	:	1124 HWY 52 W BY PASS
Second Line	:
City	:	WESTMORELAND
State	:	TN
Zip	:	37186
Country	:	US
Telephone Number	:	615-644-4203
Fax Number	:	615-644-4228

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

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	04/13/2010

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