Provider Demographics
NPI:1902862956
Name:BONDE, SUNITA SUDHAKAR (DO)
Entity Type:Individual
Prefix:
First Name:SUNITA
Middle Name:SUDHAKAR
Last Name:BONDE
Suffix:
Gender:F
Credentials:DO
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 3925
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71133-3925
Mailing Address - Country:US
Mailing Address - Phone:800-684-1591
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:1400 BRADEN ST
Practice Address - Street 2:ER DEPT
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-3721
Practice Address - Country:US
Practice Address - Phone:501-985-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015930207P00000X
ARE-8023207P00000X
OH34.007475207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199531003Medicaid
ARP01238814OtherRAILROAD MCARE
MI4728518Medicaid
MIM50940056OtherWA FOOTE MEMORIAL
ARP01238814OtherRAILROAD MCARE
AR199531003Medicaid