Provider Demographics
NPI:1134128515
Name:SURESH M DASANI MD INC
Entity Type:Organization
Organization Name:SURESH M DASANI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:MADHAVJI
Authorized Official - Last Name:DASANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:419-726-7070
Mailing Address - Street 1:2755 SHORELAND AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1177
Mailing Address - Country:US
Mailing Address - Phone:419-726-7070
Mailing Address - Fax:419-726-3621
Practice Address - Street 1:2755 SHORELAND AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611-1177
Practice Address - Country:US
Practice Address - Phone:419-726-7070
Practice Address - Fax:419-726-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054340207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699687Medicaid
OHA03136Medicare UPIN
9318521Medicare ID - Type Unspecified