Provider Demographics
NPI:1649206988
Name:SURATI, NATVERLAL B (MD)
Entity Type:Individual
Prefix:MR
First Name:NATVERLAL
Middle Name:B
Last Name:SURATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3327
Mailing Address - Country:US
Mailing Address - Phone:773-248-8644
Mailing Address - Fax:773-248-8723
Practice Address - Street 1:1045 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3327
Practice Address - Country:US
Practice Address - Phone:773-248-8644
Practice Address - Fax:773-248-8723
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-069532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069532Medicaid