Provider Demographics
NPI:1497069785
Name:NARAYANASAMY, SURESH RAMASAMY (RPT)
Entity Type:Individual
Prefix:MR
First Name:SURESH
Middle Name:RAMASAMY
Last Name:NARAYANASAMY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 W US HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2455
Mailing Address - Country:US
Mailing Address - Phone:989-560-7610
Mailing Address - Fax:
Practice Address - Street 1:200 SHERMAN OAKS DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2932
Practice Address - Country:US
Practice Address - Phone:989-560-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501014764OtherSTATE OF MICHIGAN