Healthcare Provider Details

I. General information

NPI: 1689187734
Provider Name (Legal Business Name): SURESH RAMASUBBAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 EDGEWATER DR # 5300
ORLANDO FL
32804-6350
US

IV. Provider business mailing address

1317 EDGEWATER DR # 5300
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 305-735-2452
  • Fax:
Mailing address:
  • Phone: 305-735-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36104175
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2018008464
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: