Provider Demographics
NPI:1063604874
Name:ASHAKIRAN J. SUNKU, M.D., LLC
Entity type:Organization
Organization Name:ASHAKIRAN J. SUNKU, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHAKIRAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUNKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-546-9500
Mailing Address - Street 1:1600 N GRAND AVE
Mailing Address - Street 2:SUITE: 110
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2700
Mailing Address - Country:US
Mailing Address - Phone:719-546-9500
Mailing Address - Fax:719-546-9503
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE: 110
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2700
Practice Address - Country:US
Practice Address - Phone:719-546-9500
Practice Address - Fax:719-546-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04023552Medicaid