Healthcare Provider Details

I. General information

NPI: 1649206988
Provider Name (Legal Business Name): NATVERLAL B SURATI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W BELMONT AVE
CHICAGO IL
60657-3327
US

IV. Provider business mailing address

1045 W BELMONT AVE
CHICAGO IL
60657-3327
US

V. Phone/Fax

Practice location:
  • Phone: 773-248-8644
  • Fax: 773-248-8723
Mailing address:
  • Phone: 773-248-8644
  • Fax: 773-248-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-069532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: