Provider Demographics
NPI:1528035268
Name:KINDLE-SUERSIN, KESI TABIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KESI
Middle Name:TABIA
Last Name:KINDLE-SUERSIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KESI
Other - Middle Name:TABIA
Other - Last Name:KINDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746724
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6724
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:312-733-9730
Practice Address - Street 1:2668 PETERS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-5655
Practice Address - Country:US
Practice Address - Phone:336-200-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200933207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
804752OtherPARTNERS
NC13153OtherBCBS
7706384OtherAETNA
NC8913153Medicaid
WV3810000708Medicaid
D6480OtherMEDCOST
NCH64259OtherUHC
VA10100496Medicaid
SCQ00933Medicaid
WV3810000708Medicaid
H64259Medicare UPIN
NCP00300064Medicare PIN
NC13153OtherBCBS