Provider Demographics
NPI:1629061874
Name:SURESH, URATH (MD)
Entity Type:Individual
Prefix:
First Name:URATH
Middle Name:
Last Name:SURESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 ALCOA HWY
Mailing Address - Street 2:C-460
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1527
Mailing Address - Country:US
Mailing Address - Phone:865-546-9246
Mailing Address - Fax:865-523-6466
Practice Address - Street 1:1932 ALCOA HWY
Practice Address - Street 2:STE C-460
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-546-9246
Practice Address - Fax:865-523-6466
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35782207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4029310OtherBLUE CROSS BLUE SHIELD
TN390008052OtherRAILROAD MEDICARE
TN3723987Medicaid
H01844Medicare UPIN
TN3869323Medicare ID - Type Unspecified