Provider Demographics
NPI:1457326183
Name:RAHEJA, SURESH (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:RAHEJA
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 1:3450 W WHEATLAND RD
Mailing Address - Street 2:SUITE #216
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3470
Mailing Address - Country:US
Mailing Address - Phone:972-709-7766
Mailing Address - Fax:972-709-7747
Practice Address - Street 1:3450 W WHEATLAND RD
Practice Address - Street 2:SUITE #216
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3470
Practice Address - Country:US
Practice Address - Phone:972-709-7766
Practice Address - Fax:972-709-7747
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098540002Medicaid
TX00G75XMedicare ID - Type Unspecified
TXE56712Medicare UPIN