Individual
SUNITA PREMKUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7910 E WASHINGTON ST STE 200, INDIANAPOLIS, IN 46219-5563
(317) 355-7171
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01061971A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000487706
ANTHEM
IN
05
—
200821720
—
IN
01
—
P00331316
RR MEDICARE
IN
01
—
P01014115
RR MEDICARE PTAN
IN
Enumeration date
05/25/2006
Last updated
01/05/2026
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