Provider Demographics
NPI:1457647950
Name:SURESH K.J. BABU MD., PA
Entity Type:Organization
Organization Name:SURESH K.J. BABU MD., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BABU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-826-8833
Mailing Address - Street 1:PO BOX 1382
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-1382
Mailing Address - Country:US
Mailing Address - Phone:979-826-8833
Mailing Address - Fax:979-826-9469
Practice Address - Street 1:350 HIGHWAY 290 E
Practice Address - Street 2:SUITE 5
Practice Address - City:HEMPSTEAD
Practice Address - State:TX
Practice Address - Zip Code:77445-5571
Practice Address - Country:US
Practice Address - Phone:979-826-8833
Practice Address - Fax:979-826-9469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty