MEDICARE: SUNITA SUDHAKAR BONDE DO

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	207P00000X	Emergency Medicine Physician	5101015930	MI
2	207P00000X	Emergency Medicine Physician	E-8023	AR
3	207P00000X	Emergency Medicine Physician	34.007475	OH

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	P01238814	OTHER	AR	RAILROAD MCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	M50940056	OTHER	MI	WA FOOTE MEMORIAL

General Provider Information

NPI Number	:	1902862956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNITA SUDHAKAR BONDE DO

Provider Business Mailing Address
First Line	:	PO BOX 3925
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71133-3925
Country	:	US
Telephone Number	:	800-684-1591
Fax Number	:	405-844-1794

Provider Business Practice Location Address
First Line	:	1400 BRADEN ST
Second Line	:	ER DEPT
City	:	JACKSONVILLE
State	:	AR
Zip	:	72076-3721
Country	:	US
Telephone Number	:	501-985-7000
Fax Number	:

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/09/2020

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Directions to “ SUNITA SUDHAKAR BONDE DO” Practice Location

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