Provider Demographics
NPI:1609816396
Name:SURESHKUMAR, AMBIKA (MD)
Entity Type:Individual
Prefix:
First Name:AMBIKA
Middle Name:
Last Name:SURESHKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMBIKA
Other - Middle Name:
Other - Last Name:KATHIRGAMATHAMBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:2900 BOCA RATON
Practice Address - Street 2:SUITE 201
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-241-0025
Practice Address - Fax:561-241-3883
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD098972L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013636300001Medicaid
PA1665558OtherPCHOICE
PA801665558OtherHIGHMARK
PA073254Medicare ID - Type Unspecified