Provider Demographics
NPI:1033313465
Name:SONAVANE, SUSHILKUMAR KADU (MD)
Entity Type:Individual
Prefix:
First Name:SUSHILKUMAR
Middle Name:KADU
Last Name:SONAVANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:205-297-9411
Practice Address - Street 1:4500 SAN PABLO RD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1865
Practice Address - Country:US
Practice Address - Phone:904-953-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20100076032085R0202X
ALL.3416SP2085R0202X
FLME1393962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051117669OtherBCBS
AL051117671OtherBCBS
AL129732Medicaid
AL129751Medicaid
AL051117672OtherBCBS
AL129730Medicaid
AL129734Medicaid
AL129746Medicaid
AL051117667OtherBCBS
AL051117673OtherBCBS
AL129724Medicaid
AL129738Medicaid
AL051117678OtherBCBS
AL051117679OtherBCBS
AL129728Medicaid
AL051117668OtherBCBS
AL051117676OtherBCBS
AL051117674OtherBCBS
AL129743Medicaid
MS07135395Medicaid
AL129750Medicaid
AL102I304689Medicare PIN