Provider Demographics
NPI:1922666924
Name:PATHAK, SUMERTH KUMAR (DO)
Entity type:Individual
Prefix:
First Name:SUMERTH
Middle Name:KUMAR
Last Name:PATHAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9519 OWL TRACE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-8951
Mailing Address - Country:US
Mailing Address - Phone:804-731-5994
Mailing Address - Fax:
Practice Address - Street 1:625 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3110
Practice Address - Country:US
Practice Address - Phone:312-766-2764
Practice Address - Fax:312-640-7736
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361653762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry