Provider Demographics
NPI:1710388251
Name:SULTAN PLLC.
Entity Type:Organization
Organization Name:SULTAN PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAHJAHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-215-1004
Mailing Address - Street 1:1206 IOLA RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2819
Mailing Address - Country:US
Mailing Address - Phone:228-215-1004
Mailing Address - Fax:228-238-3035
Practice Address - Street 1:1019 GOVERNMENT ST
Practice Address - Street 2:STE. D
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3860
Practice Address - Country:US
Practice Address - Phone:228-215-1004
Practice Address - Fax:228-238-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty