Provider Demographics
NPI:1194787960
Name:SIDHARTHAN, KUSUMAM (MD)
Entity type:Individual
Prefix:DR
First Name:KUSUMAM
Middle Name:
Last Name:SIDHARTHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:916 E BURNS DR
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1407
Mailing Address - Country:US
Mailing Address - Phone:956-994-9100
Mailing Address - Fax:956-994-9101
Practice Address - Street 1:222 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1251
Practice Address - Country:US
Practice Address - Phone:956-994-9100
Practice Address - Fax:956-994-9101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG96612080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine