Provider Demographics
NPI:1033757802
Name:MARK S. SUMIDA, MD PLLC
Entity Type:Organization
Organization Name:MARK S. SUMIDA, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-877-4705
Mailing Address - Street 1:1724 HAMILL RD STE 204
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5098
Mailing Address - Country:US
Mailing Address - Phone:423-877-4705
Mailing Address - Fax:423-877-9970
Practice Address - Street 1:1724 HAMILL RD STE 204
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5098
Practice Address - Country:US
Practice Address - Phone:423-877-4705
Practice Address - Fax:423-877-9970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty