Provider Demographics
NPI:1649217639
Name:RATNAM, SURESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:
Last Name:RATNAM
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1901 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1271
Practice Address - Country:US
Practice Address - Phone:956-687-5150
Practice Address - Fax:956-687-9546
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0165207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000L7773Medicaid
TX136454912Medicaid
TX134716304Medicaid
TX8R1530OtherBLUE CROSS OF TEXAS
TX134716305Medicaid
TX134716306OtherCSHCN
TX8R1530OtherBLUE CROSS OF TEXAS
TX134716306OtherCSHCN
TX134716304Medicaid
TX134716301Medicaid
G31372Medicare UPIN
TX010056656Medicare PIN