Provider Demographics
NPI:1235457375
Name:SURI KARTHIKEYAN MDPC
Entity Type:Organization
Organization Name:SURI KARTHIKEYAN MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURI
Authorized Official - Middle Name:
Authorized Official - Last Name:KARTHIKEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-637-8580
Mailing Address - Street 1:156 WEST AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1229
Mailing Address - Country:US
Mailing Address - Phone:585-637-8580
Mailing Address - Fax:585-637-0471
Practice Address - Street 1:156 WEST AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1229
Practice Address - Country:US
Practice Address - Phone:585-637-8580
Practice Address - Fax:585-637-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220745207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF99228Medicare UPIN