Provider Demographics
NPI:1659441327
Name:KARRA, SURESH REDDY
Entity Type:Individual
Prefix:MR
First Name:SURESH
Middle Name:REDDY
Last Name:KARRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17838 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2139
Mailing Address - Country:US
Mailing Address - Phone:708-532-5350
Mailing Address - Fax:815-550-8703
Practice Address - Street 1:17838 HARPER RD
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2139
Practice Address - Country:US
Practice Address - Phone:708-532-5350
Practice Address - Fax:815-550-8703
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist