Provider Demographics
NPI:1114081379
Name:BATTU, SURYA K (MD)
Entity Type:Individual
Prefix:
First Name:SURYA
Middle Name:K
Last Name:BATTU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17510 W GRAND PKWY S
Mailing Address - Street 2:SUITE # 340
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2645
Mailing Address - Country:US
Mailing Address - Phone:281-342-7111
Mailing Address - Fax:281-342-9111
Practice Address - Street 1:17510 W GRAND PKWY S
Practice Address - Street 2:SUITE # 340
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2645
Practice Address - Country:US
Practice Address - Phone:281-342-7111
Practice Address - Fax:281-342-9111
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091906001Medicaid
TX091906001Medicaid