Provider Demographics
NPI:1740493204
Name:KUMARAN, SUGANTHI SENTHIL (MD)
Entity type:Individual
Prefix:
First Name:SUGANTHI
Middle Name:SENTHIL
Last Name:KUMARAN
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 1:3414 OLD FIELD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2793
Mailing Address - Country:US
Mailing Address - Phone:812-377-6020
Mailing Address - Fax:812-377-6024
Practice Address - Street 1:605 COTTAGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6074
Practice Address - Country:US
Practice Address - Phone:812-377-6020
Practice Address - Fax:812-377-6024
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058133A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
105889Medicare UPIN
IN144670EMedicare ID - Type Unspecified