Provider Demographics
NPI:1609000447
Name:SURESH RAHEJA M.D PA
Entity Type:Organization
Organization Name:SURESH RAHEJA M.D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHEJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-709-7766
Mailing Address - Street 1:3430 W WHEATLAND RD
Mailing Address - Street 2:118
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3446
Mailing Address - Country:US
Mailing Address - Phone:972-709-7766
Mailing Address - Fax:
Practice Address - Street 1:3430 W WHEATLAND RD
Practice Address - Street 2:118
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3446
Practice Address - Country:US
Practice Address - Phone:972-709-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE56712Medicare UPIN