Provider Demographics
NPI:1356508071
Name:SUMEET KUMAR MENDONCA MD PC
Entity Type:Organization
Organization Name:SUMEET KUMAR MENDONCA MD PC
Other - Org Name:SUMEET KUMAR MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUMEET
Authorized Official - Middle Name:K
Authorized Official - Last Name:MENDONCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-969-3637
Mailing Address - Street 1:1432 S DOBSON RD
Mailing Address - Street 2:106
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4768
Mailing Address - Country:US
Mailing Address - Phone:480-969-3637
Mailing Address - Fax:480-969-6568
Practice Address - Street 1:1432 S DOBSON RD
Practice Address - Street 2:106
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4768
Practice Address - Country:US
Practice Address - Phone:480-969-3637
Practice Address - Fax:480-969-6568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty