Healthcare Provider Details

I. General information

NPI: 1346413036
Provider Name (Legal Business Name): SURESH TUNGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 MERIT DR STE 600
DALLAS TX
75251-3294
US

IV. Provider business mailing address

4801 NW LOOP 410 STE 300
SAN ANTONIO TX
78229-5343
US

V. Phone/Fax

Practice location:
  • Phone: 972-715-5000
  • Fax: 972-715-9976
Mailing address:
  • Phone: 210-575-7827
  • Fax: 210-575-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA112873
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberA112873
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberP0303
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP0303
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: