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NPI Code Detail

MEDICARE: SURESH N GADASALLI M D P A

MEDICARE: SURESH N GADASALLI M D P A
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
1207RC0000XCardiovascular Disease PhysicianJ5765TX

Other Identifiers

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

General Provider Information

NPI Number : 1427050780
Entity Type Code : Organization
Provider Name (Legal Business Name) : SURESH N GADASALLI M D P A
Provider Business Mailing Address
First Line : PO BOX 362
Second Line :
City : ODESSA
State : TX
Zip : 79760-0362
Country : US
Telephone Number : 432-580-5891
Fax Number : 432-582-2302
Provider Business Practice Location Address
First Line : 500 E 4TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-5110
Country : US
Telephone Number : 432-580-8686
Fax Number : 432-580-8383
Authorized Official
Title or Position : PRESIDENT
Name : DR. SURESH NAGARAJ GADASALLI
Credential : M.D.
Telephone Number : 432-580-5891
Provider Enumeration Date : 06/01/2005
Last Update Date : 02/19/2014

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Directions to “SURESH N GADASALLI M D P A ” Practice Location

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