Provider Demographics
NPI:1124222716
Name:SUGUMAR, ARAVIND (MD)
Entity type:Individual
Prefix:DR
First Name:ARAVIND
Middle Name:
Last Name:SUGUMAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N DYSART RD STE G127
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1011
Mailing Address - Country:US
Mailing Address - Phone:623-322-0323
Mailing Address - Fax:623-322-0757
Practice Address - Street 1:3400 N DYSART RD STE G127
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1011
Practice Address - Country:US
Practice Address - Phone:623-322-0323
Practice Address - Fax:623-322-0757
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN50574207RG0100X
MNTEMP207RG0100X
AZ55744207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS04-35128OtherMEDICAL LICENSE
MNP00629425OtherMEDICARE, RAILROAD
MN949688100Medicaid
944717668OtherMYUTMB 944717668-COMMERCIAL NUMBER
MN949688100Medicaid