Provider Demographics
NPI:1841369907
Name:MALHOTRA, SUNIL (MD)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 GOODMAN RD E
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9557
Mailing Address - Country:US
Mailing Address - Phone:662-536-3330
Mailing Address - Fax:662-536-3329
Practice Address - Street 1:470 GOODMAN ROAD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9557
Practice Address - Country:US
Practice Address - Phone:662-536-3330
Practice Address - Fax:662-536-3329
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117366Medicaid
MS00117366Medicaid
G00516Medicare UPIN