Provider Demographics
NPI:1417045527
Name:CHAKRAVORTY, SUMANT K (MD)
Entity Type:Individual
Prefix:
First Name:SUMANT
Middle Name:K
Last Name:CHAKRAVORTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5431 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4639
Mailing Address - Country:US
Mailing Address - Phone:954-344-2522
Mailing Address - Fax:954-344-9189
Practice Address - Street 1:125 W INDIANTOWN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3556
Practice Address - Country:US
Practice Address - Phone:561-748-8103
Practice Address - Fax:561-748-0773
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL650190533207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL035047800Medicaid
FLD20897Medicare UPIN
FL04239Medicare ID - Type Unspecified