Provider Demographics
NPI:1780446914
Name:SUMI PHYSICIAN SERVICES PLLC
Entity type:Organization
Organization Name:SUMI PHYSICIAN SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:UNKNOWN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIYANKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-897-0270
Mailing Address - Street 1:911 INDEPENDENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8463
Mailing Address - Country:US
Mailing Address - Phone:715-897-0270
Mailing Address - Fax:
Practice Address - Street 1:1207 S WHITE CHAPEL BLVD STE 275
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-9345
Practice Address - Country:US
Practice Address - Phone:682-416-9120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty