Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD202111 | LA |
N | 2080P0204X | Pediatric Emergency Doctor | 202111 | LA |
NPI | 1184826968 |
---|---|
Provider Name | Susmitha Anumukonda |
First Address | Shreveport, LA 71118-3112 |
Second Address | Shreveport, LA 71118-3112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 06/07/2021 |