Provider Demographics
NPI:1073754057
Name:SUMICH, BRENDON (MD)
Entity Type:Individual
Prefix:
First Name:BRENDON
Middle Name:
Last Name:SUMICH
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 1:3409 N HULLEN ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3486
Mailing Address - Country:US
Mailing Address - Phone:504-888-2600
Mailing Address - Fax:504-456-9596
Practice Address - Street 1:3409 N HULLEN ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-3486
Practice Address - Country:US
Practice Address - Phone:504-888-2600
Practice Address - Fax:504-456-9596
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMA204189207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1956601Medicaid