MEDICARE: SURESH M DASANI MD INC

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	35054340	OH

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	:	1134128515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURESH M DASANI MD INC

Provider Business Mailing Address
First Line	:	2755 SHORELAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-1177
Country	:	US
Telephone Number	:	419-726-7070
Fax Number	:	419-726-3621

Provider Business Practice Location Address
First Line	:	2755 SHORELAND AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43611-1177
Country	:	US
Telephone Number	:	419-726-7070
Fax Number	:	419-726-3621

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SURESH MADHAVJI DASANI
Credential	:	M.D.,
Telephone Number	:	419-726-7070

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	09/01/2010

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