Provider Demographics
NPI:1730717554
Name:PUSKOOR, SUJITH RAO (DO)
Entity type:Individual
Prefix:
First Name:SUJITH
Middle Name:RAO
Last Name:PUSKOOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 UNIVERSITY BLVD STE 345
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1058
Mailing Address - Country:US
Mailing Address - Phone:512-509-0200
Mailing Address - Fax:
Practice Address - Street 1:425 UNIVERSITY BLVD STE 345
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1058
Practice Address - Country:US
Practice Address - Phone:512-509-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program