Provider Demographics
NPI:1962537233
Name:HARJIT SUD M.D&THOMAS T. STREETER M.D. PROFESSIONAL CORP
Entity type:Organization
Organization Name:HARJIT SUD M.D&THOMAS T. STREETER M.D. PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-957-1000
Mailing Address - Street 1:2509 W MARCH LN
Mailing Address - Street 2:STE.250
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-8252
Mailing Address - Country:US
Mailing Address - Phone:209-957-1000
Mailing Address - Fax:209-957-1001
Practice Address - Street 1:2509 W MARCH LN
Practice Address - Street 2:SUITE 250
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8252
Practice Address - Country:US
Practice Address - Phone:209-957-1000
Practice Address - Fax:209-957-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty