Provider Demographics
NPI:1386830354
Name:SOODA, KUSUMAKAR (MD)
Entity Type:Individual
Prefix:
First Name:KUSUMAKAR
Middle Name:
Last Name:SOODA
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 1:6330 SARATOGA BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3481
Mailing Address - Country:US
Mailing Address - Phone:248-345-7383
Mailing Address - Fax:
Practice Address - Street 1:6330 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3481
Practice Address - Country:US
Practice Address - Phone:248-345-7383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1458207Q00000X
FLME155378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty