Provider Demographics
NPI:1609832310
Name:KAMATH, SURESH (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:KAMATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5504
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:STE 6000
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-475-8524
Practice Address - Fax:513-475-7327
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2017-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-080547207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200376230Medicaid
OH2342398Medicaid
KY64052111Medicaid
OHP00053562OtherRAIL ROAD MEDICARE
OH0847257Medicare PIN
IN200376230Medicaid
G7224Medicare UPIN