Provider Demographics
NPI:1326365289
Name:SURYAWALA, KUNAL (MD)
Entity Type:Individual
Prefix:
First Name:KUNAL
Middle Name:
Last Name:SURYAWALA
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 1:11181 HEALTH PARK BLVD STE 2220
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5734
Mailing Address - Country:US
Mailing Address - Phone:239-624-8070
Mailing Address - Fax:239-624-8071
Practice Address - Street 1:11181 HEALTH PARK BLVD STE 2220
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5734
Practice Address - Country:US
Practice Address - Phone:239-624-8070
Practice Address - Fax:239-624-8071
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME127721207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017768800Medicaid
FL02JB9OtherBCBS
FLIQ298ZOtherMEDICARE
FLIQ298ZMedicare UPIN