MEDICARE: DR. SURESH KUMAR MISRA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MT198274	PA
2	207RG0100X	Gastroenterology Physician	R77497	AZ

General Provider Information

NPI Number	:	1013228964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESH KUMAR MISRA M.D.

Provider Business Mailing Address
First Line	:	820 BESTGATE RD
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3404
Country	:	US
Telephone Number	:	410-224-2116
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 N CAMPBELL AVENUE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-4105
Country	:	US
Telephone Number	:	520-626-6743
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	06/11/2022

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