Provider Demographics
NPI:1275988933
Name:JEGANATHAN, SUNIL KUMAR (MD, DPM)
Entity type:Individual
Prefix:
First Name:SUNIL
Middle Name:KUMAR
Last Name:JEGANATHAN
Suffix:
Gender:M
Credentials:MD, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VISION PARK BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3004
Mailing Address - Country:US
Mailing Address - Phone:936-273-6000
Mailing Address - Fax:936-273-6022
Practice Address - Street 1:111 VISION PARK BLVD STE 240
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3004
Practice Address - Country:US
Practice Address - Phone:936-273-6000
Practice Address - Fax:936-273-6022
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2385213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist