Provider Demographics
NPI:1033974324
Name:LAREDO INTERVENTIONAL CLINIC PLLC
Entity Type:Organization
Organization Name:LAREDO INTERVENTIONAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DINESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SUNDARAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-691-6768
Mailing Address - Street 1:7019 W VILLAGE BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2223
Mailing Address - Country:US
Mailing Address - Phone:717-275-5869
Mailing Address - Fax:
Practice Address - Street 1:7019 W VILLAGE BLVD
Practice Address - Street 2:STE 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2223
Practice Address - Country:US
Practice Address - Phone:717-275-5869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty