Provider Demographics
NPI:1346231156
Name:PATEL, SURESH J (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SURESHCHANDRA
Other - Middle Name:J
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:804 N MONCEAUX AVE
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-2013
Mailing Address - Country:US
Mailing Address - Phone:337-643-6430
Mailing Address - Fax:337-643-1525
Practice Address - Street 1:804 N MONCEAUX AVE
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-2013
Practice Address - Country:US
Practice Address - Phone:337-643-6430
Practice Address - Fax:337-643-1525
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05619R207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1316415Medicaid
LA1316415Medicaid
B65341Medicare UPIN