Provider Demographics
NPI:1205831831
Name:SURTI, NEIL HANS (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:HANS
Last Name:SURTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4928
Practice Address - Street 1:24630 STATE ROAD 54
Practice Address - Street 2:BUILDING 3
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7307
Practice Address - Country:US
Practice Address - Phone:813-948-3903
Practice Address - Fax:813-948-4157
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87651208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267647800Medicaid
FL267647800Medicaid