Basic Information
| Provider Information | |||||||||
| NPI: | 1598068736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUKUMARAN | ||||||||
| FirstName: | SUKESH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 VALLEY CHILDRENS PL # GE10 | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936368761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593536450 | ||||||||
| FaxNumber: | 5593537214 | ||||||||
| Practice Location | |||||||||
| Address1: | 9300 VALLEY CHILDRENS PL # GE10 | ||||||||
| Address2: | |||||||||
| City: | MADERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5593536450 | ||||||||
| FaxNumber: | 5593537214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2010 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0216X | E-8979 | AR | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | 2080P0216X | ME109540 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | 2080P0216X | A103325 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 003600600 | 05 | FL | MEDICAID |