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General NPI Number Information
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NPI Number | 1023426947
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Entity Type | Organization
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Legal Business Name | SURESH SUREDDI MD LLC
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 12/11/2014
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Provider Practice Location Address
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Address Line | 730 E PARK BLVD 120
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City | PLANO
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State | TX
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Zip | 75074-5451
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Country | US
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Telephone | 214-908-1255
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Fax | 888-393-5982
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Provider Business Mailing Address
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Address Line | BOX 213, 120 E. FM 544 72
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City | MURPHY
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State | TX
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Zip | 75094-4035
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Country | US
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Telephone | 214-908-1255
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Fax | 888-393-5982
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Authorized Official
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Title or Position | CEO
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Name | DR. SURESH SUREDDI
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Credential | MD
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Telephone | 214-908-1255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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