Provider Demographics
NPI:1356587950
Name:SOMPUR VASANTHKUMAR, SUSHIL KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SUSHIL KUMAR
Middle Name:
Last Name:SOMPUR VASANTHKUMAR
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 1:1919 ELM ST N
Mailing Address - Street 2:DEPARTMENT OF CLINICAL NEUROSCIENCE
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2416
Mailing Address - Country:US
Mailing Address - Phone:701-293-4101
Mailing Address - Fax:701-293-4109
Practice Address - Street 1:1919 ELM ST N
Practice Address - Street 2:DEPARTMENT OF CLINICAL NEUROSCIENCE
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2416
Practice Address - Country:US
Practice Address - Phone:701-293-4101
Practice Address - Fax:701-293-4109
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL105682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry