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General NPI Number Information
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NPI Number | 1871761338
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Entity Type | Organization
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Legal Business Name | SURESH B INDUPALLI MD PA
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 10/11/2017
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Provider Practice Location Address
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Address Line | 4180 DELAWARE ST STE 102
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City | BEAUMONT
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State | TX
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Zip | 77706-7859
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Country | US
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Telephone | 409-835-4907
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Fax | 409-347-0070
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Provider Business Mailing Address
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Address Line | 4180 DELAWARE ST STE 102
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City | BEAUMONT
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State | TX
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Zip | 77706-7859
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Country | US
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Telephone | 409-835-4907
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Fax | 409-347-0070
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | KERRIE THOMAS
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Credential |
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Telephone | 409-835-4907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LO828
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License Number State | TX
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