Provider Demographics
NPI:1598068736
Name:SUKUMARAN, SUKESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SUKESH
Middle Name:
Last Name:SUKUMARAN
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 1:9300 VALLEY CHILDRENS PL # GE10
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-6450
Mailing Address - Fax:559-353-7214
Practice Address - Street 1:9300 VALLEY CHILDRENS PL # GE10
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636
Practice Address - Country:US
Practice Address - Phone:559-353-6450
Practice Address - Fax:559-353-7214
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-89792080P0216X
FLME1095402080P0216X
CAA1033252080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003600600Medicaid
FLFH196ZMedicare PIN