Individual
MRS. LATHA SUKUMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2301 S CLEAR CREEK RD STE 112, KILLEEN, TX 76549-4198
(254) 519-3131
(254) 519-3133
Mailing address
2301 S. CLEAR CREEK RD SUITE 112, KILLEEN, TX 76549-4198
(254) 519-3131
(254) 519-3133
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
J3626
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036293102
—
TX
Enumeration date
11/10/2005
Last updated
02/08/2010
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