Provider Demographics
NPI:1073745493
Name:SUMMIT GERIATRICS LLC
Entity Type:Organization
Organization Name:SUMMIT GERIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:AKKULUGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-271-8676
Mailing Address - Street 1:PO BOX 7612
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-0612
Mailing Address - Country:US
Mailing Address - Phone:913-271-8676
Mailing Address - Fax:888-856-3199
Practice Address - Street 1:200 NE MISSOURI RD STE 200
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4722
Practice Address - Country:US
Practice Address - Phone:913-271-8676
Practice Address - Fax:888-856-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty