Provider Demographics
NPI:1285844803
Name:NAGENDRAN, SUKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUKUMAR
Middle Name:
Last Name:NAGENDRAN
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 1:1434 W PORT AU PRINCE LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-5108
Mailing Address - Country:US
Mailing Address - Phone:602-795-5820
Mailing Address - Fax:602-942-7628
Practice Address - Street 1:1434 W PORT AU PRINCE LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-5108
Practice Address - Country:US
Practice Address - Phone:602-795-5820
Practice Address - Fax:602-942-7628
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine