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General NPI Number Information
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NPI Number | 1992903124
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Entity Type | Organization
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Legal Business Name | SURESH R NAIK MD SC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 10/27/2008
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Provider Practice Location Address
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Address Line | 3535 30TH AVE SUITE 207
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City | KENOSHA
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State | WI
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Zip | 53144-1632
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Country | US
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Telephone | 262-658-1618
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Fax | 262-654-4562
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Provider Business Mailing Address
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Address Line | 3535 30TH AVE SUITE 207
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City | KENOSHA
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State | WI
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Zip | 53144-1632
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Country | US
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Telephone | 262-658-1618
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Fax | 262-654-4562
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Authorized Official
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Title or Position | OWNER
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Name | DR. SURESH R NAIK
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Credential | M.D.
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Telephone | 262-658-1618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20553
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License Number State | WI
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