Provider Demographics
NPI:1114923943
Name:KATAKKAR, SURESH B (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:B
Last Name:KATAKKAR
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 1:1891 W ORANGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1116
Mailing Address - Country:US
Mailing Address - Phone:520-742-4183
Mailing Address - Fax:520-742-4110
Practice Address - Street 1:1891 W ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1116
Practice Address - Country:US
Practice Address - Phone:520-742-4183
Practice Address - Fax:520-742-4110
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11471207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ215336Medicaid
AZ215336Medicaid
AZZ24540Medicare ID - Type Unspecified