1073558383 NPI number — SURENDER KURAPATI MD

Table of content: SURENDER KURAPATI MD (NPI 1073558383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073558383 NPI number — SURENDER KURAPATI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KURAPATI
Provider First Name:
SURENDER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073558383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1770 IOWA AVE STE 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92507-7401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-786-0801
Provider Business Mailing Address Fax Number:
734-677-7407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 HARRINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CLEMENS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48043-2920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-493-8098
Provider Business Practice Location Address Fax Number:
586-493-8706
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME110793 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 4301047552 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q47552 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 310E011330 . This is a "BCBS GROUP #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4458682 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3005011051 . This is a "BCBS INDIVIDUAL PIN #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4267902 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300119457 . This is a "MEDICARE RR PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 105220500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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