MEDICARE: DR. SURYAM KODALI

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	174400000X	Specialist	F2307	TX

General Provider Information

NPI Number	:	1669554218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURYAM KODALI

Provider Business Mailing Address
First Line	:	7737 SOUTHWEST FWY STE 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1800
Country	:	US
Telephone Number	:	713-777-1141
Fax Number	:	713-270-7714

Provider Business Practice Location Address
First Line	:	7737 SOUTHWEST FWY STE 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-1800
Country	:	US
Telephone Number	:	713-777-1141
Fax Number	:	713-270-7714

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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