Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | A103325 | CA |
N | 2080P0216X | Pediatric Rheumatologist | E-8979 | AR |
N | 2080P0216X | Pediatric Rheumatologist | ME109540 | FL |
NPI | 1598068736 |
---|---|
Provider Name | Dr. Sukesh Sukumaran |
First Address | Madera, CA 93636-8761 |
Second Address | Madera, CA 93636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2010 |
Last Update Date | 26/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003600600 | (05) | FL |