Viktor P Sulkowski, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD0000010318 Issued in TN

Practice address

10461 Wallace Alley St
Kingsport, TN 37663-3936

Phone

(423) 279-1400

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1780796003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 BROWNS MILL RD STE 6 PMB 386",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044100",
            "telephone_number": "423-854-0001",
            "fax_number": "423-854-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10461 WALLACE ALLEY ST",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376633936",
            "telephone_number": "423-279-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULKOWSKI",
        "first_name": "VIKTOR",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TN",
            "license": "MD0000010318",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TN PROVIDER NUMBER",
            "identifier": "4051152",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS TN GRP PROVIDER NUMB",
            "identifier": "4051167",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3379190",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristine Marie Stultz, PHARMD
• Thomas E Sturdavant, MD
• Faith Sturgill
• Mechele Lea Stykes, HIS
• Meeradevi Sudarsanan, NP
• Sullivan and PTRS
• Sullivan County Regional Health Department
• Hugh M. Sullivan
• Lauren Sullivan, PHARMD
• Michael Jude Sullivan, M.D.

• Specialist in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.