Provider Demographics
NPI:1740272756
Name:SRINANTHAKUMAR, SAKUNTALAI (MD)
Entity type:Individual
Prefix:DR
First Name:SAKUNTALAI
Middle Name:
Last Name:SRINANTHAKUMAR
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 1:740 HOSPITAL DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4664
Mailing Address - Country:US
Mailing Address - Phone:409-839-8349
Mailing Address - Fax:409-839-4220
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 180
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4664
Practice Address - Country:US
Practice Address - Phone:409-839-8848
Practice Address - Fax:409-839-4220
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2024-05-07
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-26
Provider Licenses
StateLicense IDTaxonomies
TXH2969207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123255505Medicaid
TXD83813Medicare UPIN
00734YMedicare ID - Type Unspecified