Provider Demographics
NPI:1417339268
Name:KAMBILIAMPATTI SUDHAKAR, ABOORVA (MD)
Entity Type:Individual
Prefix:DR
First Name:ABOORVA
Middle Name:
Last Name:KAMBILIAMPATTI SUDHAKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ABOORVA
Other - Middle Name:K
Other - Last Name:SUDHAKAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:107 MILLSAPS DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1348
Mailing Address - Country:US
Mailing Address - Phone:601-268-5131
Mailing Address - Fax:601-268-5138
Practice Address - Street 1:107 MILLSAPS DR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1348
Practice Address - Country:US
Practice Address - Phone:601-268-5131
Practice Address - Fax:601-268-5138
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS27949207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism