Provider Demographics
NPI:1891100632
Name:BHOSREKAR, SUGANDHA KIRANKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SUGANDHA
Middle Name:KIRANKUMAR
Last Name:BHOSREKAR
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 591790
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0139
Mailing Address - Country:US
Mailing Address - Phone:573-307-0500
Mailing Address - Fax:888-371-0337
Practice Address - Street 1:17720 CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-3500
Practice Address - Country:US
Practice Address - Phone:210-616-6406
Practice Address - Fax:888-371-0337
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU66872084P0800X
AZ657472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry