Healthcare Provider Details

I. General information

NPI: 1689937427
Provider Name (Legal Business Name): SURESH SESHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8535 N CLEARVIEW DR STE 400
MCCORDSVILLE IN
46055-6241
US

IV. Provider business mailing address

8535 N CLEARVIEW DR STE 400
MCCORDSVILLE IN
46055-6241
US

V. Phone/Fax

Practice location:
  • Phone: 317-335-6930
  • Fax:
Mailing address:
  • Phone: 317-335-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301101165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: