Provider Demographics
NPI:1184760274
Name:SUMRA, KULVINDER (MD)
Entity type:Individual
Prefix:DR
First Name:KULVINDER
Middle Name:
Last Name:SUMRA
Suffix:
Gender:M
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 380
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-0380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 MOUNTAIN ST E
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-4015
Practice Address - Country:US
Practice Address - Phone:701-265-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDMEDICAIDMedicaid
NDMEDICAREMedicare ID - Type Unspecified21766
NDMEDICAIDMedicaid