Provider Demographics
NPI:1902966153
Name:DANIEL D SUMROK, MD
Entity type:Organization
Organization Name:DANIEL D SUMROK, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SUMROK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-352-0603
Mailing Address - Street 1:1894 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-2206
Mailing Address - Country:US
Mailing Address - Phone:731-352-0603
Mailing Address - Fax:731-352-0185
Practice Address - Street 1:1894 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-2206
Practice Address - Country:US
Practice Address - Phone:731-352-0603
Practice Address - Fax:731-352-0185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD21860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty