Provider Demographics
NPI:1699800714
Name:SUGAR CREEK MEDICAL CENTER, P.A.
Entity type:Organization
Organization Name:SUGAR CREEK MEDICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUBODH
Authorized Official - Middle Name:
Authorized Official - Last Name:SONWALKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-313-2255
Mailing Address - Street 1:1807 LAKEBEND DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3979
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1602 SOUTH PARKWAY BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3425
Practice Address - Country:US
Practice Address - Phone:281-313-2255
Practice Address - Fax:281-313-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00334YMedicare ID - Type Unspecified