Physician Practice of Madison, PC

NPI #1114476389 in Vicksburg, Mississippi

Provider Information

NPI Number: 1114476389
Entity Type: Organization
Organization Name: Physician Practice of Madison, PC
Primary Specialty: Specialist
Enumeration Date: Sep 28, 2016
Last Updated: Sep 28, 2016

Practice Location

Address: 1111 N FRONTAGE RD FL 2
City: Vicksburg
State: Mississippi
ZIP Code: 39180-5102
Phone: (412) 721-2417

Authorized Official

Name: DR. SHAHJAHAN SULTAN, M.D.
Title: CEO
Phone: (412) 721-2417

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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