Provider Demographics
NPI:1124222716
Name:SUGUMAR, ARAVIND (MD)
Entity Type:Individual
Prefix:DR
First Name:ARAVIND
Middle Name:
Last Name:SUGUMAR
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 1:3901 RAINBOW BLVD
Mailing Address - Street 2:RM 4035 WESCOE MAILSTOP 1023
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6003
Mailing Address - Fax:913-588-3975
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:4035 WESCOE MAILSTOP 1023
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNTEMP207RG0100X
MN50574207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN949688100Medicaid
MNP00629425OtherMEDICARE, RAILROAD
KS04-35128OtherMEDICAL LICENSE
944717668OtherMYUTMB 944717668-COMMERCIAL NUMBER
MN949688100Medicaid