=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760563878
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SURAJ A. NAIK M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 05/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 N WALDROP DR STE 509
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76012-4705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-394-4300
-----------------------------------------------------
Fax | 817-394-0200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 35629
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75235-0629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-424-2213
-----------------------------------------------------
Fax | 214-231-2159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | M5397
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------