MEDICARE: DR. SELVIN SUDHAKAR 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	207RC0000X	Cardiovascular Disease Physician	P2067	TX
2	207R00000X	Internal Medicine Physician	E4625	AR
3	207R00000X	Internal Medicine Physician	P2067	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598785321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SELVIN SUDHAKAR MD

Provider Business Mailing Address
First Line	:	2200 NASA PARKWAY
Second Line	:	SUITE 220
City	:	HOUSTON
State	:	TX
Zip	:	77058-3749
Country	:	US
Telephone Number	:	281-333-9200
Fax Number	:	281-333-3570

Provider Business Practice Location Address
First Line	:	2200 NASA PARKWAY
Second Line	:	SUITE 220
City	:	HOUSTON
State	:	TX
Zip	:	77058-3749
Country	:	US
Telephone Number	:	281-333-9200
Fax Number	:	281-333-3570

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2024

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