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General NPI Number Information
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NPI Number | 1306057849
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Entity Type | Organization
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Legal Business Name | MADHAV SURI MD, INC
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 7151 N CEDAR AVE STE 102
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City | FRESNO
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State | CA
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Zip | 93720-3389
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Country | US
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Telephone | 559-322-7766
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Fax | 559-322-7120
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Provider Business Mailing Address
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Address Line | PO BOX 25548
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City | FRESNO
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State | CA
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Zip | 93729-5548
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Country | US
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Telephone | 559-322-7766
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Fax | 559-322-7120
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Authorized Official
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Title or Position | MEDICAL BILLER
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Name | RAQUEL DE LOS SANTOS
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Credential |
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Telephone | 559-322-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A51804
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License Number State | CA
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