MEDICARE: DR. KESI TABIA KINDLE-SUERSIN MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	200200933	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	804752	OTHER		PARTNERS
2	13153	OTHER	NC	BCBS
3	7706384	OTHER		AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	D6480	OTHER		MEDCOST
7	H64259	OTHER	NC	UHC
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528035268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KESI TABIA KINDLE-SUERSIN MD

Provider Business Mailing Address
First Line	:	PO BOX 746724
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6724
Country	:	US
Telephone Number	:	312-733-9730
Fax Number	:	312-733-9730

Provider Business Practice Location Address
First Line	:	2668 PETERS CREEK PKWY
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5655
Country	:	US
Telephone Number	:	336-200-7020
Fax Number	:

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	07/21/2023

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