Healthcare Provider Details

I. General information

NPI: 1710098132
Provider Name (Legal Business Name): SURESH KUKREJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 PEGGY LN
GARLAND TX
75042-5732
US

IV. Provider business mailing address

2241 PEGGY LN
GARLAND TX
75042-5732
US

V. Phone/Fax

Practice location:
  • Phone: 972-276-0571
  • Fax: 972-276-0573
Mailing address:
  • Phone: 972-276-0571
  • Fax: 972-276-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF5991
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: