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General NPI Number Information
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NPI Number | 1154958767
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Entity Type | Individual
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Provider Name | REBA SURI MD
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 11520 W 119TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2002
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Country | US
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Telephone | 913-232-9372
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Fax | 913-344-3665
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Provider Business Mailing Address
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Address Line | 11520 W 119TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2002
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Country | US
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Telephone | 913-232-9372
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Fax | 913-344-3665
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 04-50350
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License Number State | KS
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