MEDICARE: DR. SURESH JOSEPH VALLOPPILLIL 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	207L00000X	Anesthesiology Physician	N3366	TX

General Provider Information

NPI Number	:	1790950483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURESH JOSEPH VALLOPPILLIL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 112
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47308-0112
Country	:	US
Telephone Number	:	800-745-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	5204 SILVER LAKE DR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7564
Country	:	US
Telephone Number	:	214-699-9297
Fax Number	:

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

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	11/17/2020

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