Provider Demographics
NPI:1073558383
Name:KURAPATI, SURENDER (MD)
Entity Type:Individual
Prefix:
First Name:SURENDER
Middle Name:
Last Name:KURAPATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 IOWA AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7401
Mailing Address - Country:US
Mailing Address - Phone:951-786-0801
Mailing Address - Fax:734-677-7407
Practice Address - Street 1:1000 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2920
Practice Address - Country:US
Practice Address - Phone:586-493-8098
Practice Address - Fax:586-493-8706
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCME1107932085R0202X
MI43010475522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ47552Medicaid
MI310E011330OtherBCBS GROUP #
MI4458682Medicaid
MI3005011051OtherBCBS INDIVIDUAL PIN #
MI4267902Medicaid
MI300119457OtherMEDICARE RR PIN
MI3005011051OtherBCBS INDIVIDUAL PIN #
MI0N78920Medicare PIN
E36973Medicare UPIN
MI4458682Medicaid