Provider Demographics
NPI:1598785321
Name:SUDHAKAR, SELVIN (MD)
Entity type:Individual
Prefix:DR
First Name:SELVIN
Middle Name:
Last Name:SUDHAKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 NASA PARKWAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3749
Mailing Address - Country:US
Mailing Address - Phone:281-333-9200
Mailing Address - Fax:281-333-3570
Practice Address - Street 1:2200 NASA PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3749
Practice Address - Country:US
Practice Address - Phone:281-333-9200
Practice Address - Fax:281-333-3570
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2067207RC0000X, 207R00000X
ARE4625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX316781903Medicaid
AR160274001Medicaid
OK200213200AMedicaid