Provider Demographics
NPI:1639127350
Name:JAVAID, SUNBAL (MD)
Entity Type:Individual
Prefix:
First Name:SUNBAL
Middle Name:
Last Name:JAVAID
Suffix:
Gender:F
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:PO BOX 771876
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-1876
Mailing Address - Country:US
Mailing Address - Phone:513-404-4166
Mailing Address - Fax:513-489-0089
Practice Address - Street 1:8350 E KEMPER RD STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1684
Practice Address - Country:US
Practice Address - Phone:513-404-4166
Practice Address - Fax:513-489-0089
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-088656207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64108723Medicaid
OH2600457Medicaid
KY64108723Medicaid