Provider Demographics
NPI:1831547660
Name:SUGUMARAN, KARTHIK (DO)
Entity type:Individual
Prefix:DR
First Name:KARTHIK
Middle Name:
Last Name:SUGUMARAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 W BAY DR STE D
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2277
Mailing Address - Country:US
Mailing Address - Phone:727-586-3751
Mailing Address - Fax:727-587-9340
Practice Address - Street 1:1258 W BAY DR STE D
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2277
Practice Address - Country:US
Practice Address - Phone:727-586-3751
Practice Address - Fax:727-587-9340
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15444208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty