MEDICARE: SURESH SUREDDI MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1023426947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURESH SUREDDI MD LLC

Provider Business Mailing Address
First Line	:	BOX 213, 120 E. FM 544
Second Line	:	72
City	:	MURPHY
State	:	TX
Zip	:	75094-4035
Country	:	US
Telephone Number	:	214-908-1255
Fax Number	:	888-393-5982

Provider Business Practice Location Address
First Line	:	730 E PARK BLVD
Second Line	:	120
City	:	PLANO
State	:	TX
Zip	:	75074-5451
Country	:	US
Telephone Number	:	214-908-1255
Fax Number	:	888-393-5982

Authorized Official
Title or Position	:	CEO
Name	:	DR. SURESH SUREDDI
Credential	:	MD
Telephone Number	:	214-908-1255

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	12/11/2014

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