Organization
SUNSHINE MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. INDIRA KEDLAYA MD (OWNER PHYSICIAN)
(719) 545-9292
Entity
Organization
Contact information
Practice address
1600 N GRAND AVE, SUITE 120, PUEBLO, CO 81003-2700
(719) 545-9292
(719) 545-9191
Mailing address
1600 N GRAND AVE, SUITE 120, PUEBLO, CO 81003-2700
(719) 545-9292
(719) 545-9191
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
44387
CO
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
44387
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
73637556
—
CO
01
—
PE2582
RR MEDICARE
—
Enumeration date
06/19/2007
Last updated
01/07/2008
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