MEDICARE: DR. SURESH B KATAKKAR M.D.

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	207RH0003X	Hematology & Oncology Physician	11471	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114923943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESH B KATAKKAR M.D.

Provider Business Mailing Address
First Line	:	1891 W ORANGE GROVE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1116
Country	:	US
Telephone Number	:	520-742-4183
Fax Number	:	520-742-4110

Provider Business Practice Location Address
First Line	:	1891 W ORANGE GROVE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1116
Country	:	US
Telephone Number	:	520-742-4183
Fax Number	:	520-742-4110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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