Provider Demographics
NPI:1922117837
Name:KURUVILLA, SUMNA E (MD)
Entity Type:Individual
Prefix:
First Name:SUMNA
Middle Name:E
Last Name:KURUVILLA
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 1:2703 BRIERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3048
Mailing Address - Country:US
Mailing Address - Phone:318-388-3151
Mailing Address - Fax:
Practice Address - Street 1:250 DESIARD PLAZA DR
Practice Address - Street 2:VA CLINIC
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-4955
Practice Address - Country:US
Practice Address - Phone:318-345-5599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11335R207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine