Healthcare Provider Details

I. General information

NPI: 1851382857
Provider Name (Legal Business Name): P SURESH NUCHIKAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 TUSCARAWAS ST W #160
CANTON OH
44708-4696
US

IV. Provider business mailing address

2600 TUSCARAWAS ST W #160
CANTON OH
44708-4696
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-9126
  • Fax: 330-454-9470
Mailing address:
  • Phone: 330-454-9126
  • Fax: 330-454-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number3535026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: