Provider Demographics
NPI:1669749214
Name:KUMMERFELDT, SANDRA JEANETTE (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEANETTE
Last Name:KUMMERFELDT
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 1:1411 N BECKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:214-947-4498
Mailing Address - Fax:214-947-8520
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-947-2385
Practice Address - Fax:214-947-2390
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT5154207R00000X
KY46838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty