Provider Demographics
NPI:1497511448
Name:SUSHMA INDUKURI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SUSHMA INDUKURI MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSHMA
Authorized Official - Middle Name:
Authorized Official - Last Name:INDUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-445-9427
Mailing Address - Street 1:120 W LADD DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1363
Mailing Address - Country:US
Mailing Address - Phone:209-445-9427
Mailing Address - Fax:
Practice Address - Street 1:530 W EATON AVE STE B
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3454
Practice Address - Country:US
Practice Address - Phone:209-445-9427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty