Provider Demographics
NPI:1508271859
Name:MANTHRI, SUKESH (MD)
Entity Type:Individual
Prefix:
First Name:SUKESH
Middle Name:
Last Name:MANTHRI
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 1:8166 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3404
Mailing Address - Country:US
Mailing Address - Phone:985-857-8093
Mailing Address - Fax:985-857-8092
Practice Address - Street 1:8166 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3404
Practice Address - Country:US
Practice Address - Phone:985-857-8093
Practice Address - Fax:985-857-8092
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.064997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine