Healthcare Provider Details

I. General information

NPI: 1326365289
Provider Name (Legal Business Name): KUNAL SURYAWALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11181 HEALTH PARK BLVD STE 2220
NAPLES FL
34110-5734
US

IV. Provider business mailing address

11181 HEALTH PARK BLVD STE 2220
NAPLES FL
34110-5734
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-8070
  • Fax: 239-624-8071
Mailing address:
  • Phone: 239-624-8070
  • Fax: 239-624-8071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME127721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: