Provider Demographics
NPI:1710112271
Name:SURIAN, MICHAEL ANDREW (AB, MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:SURIAN
Suffix:
Gender:M
Credentials:AB, MD, FACS
Other - Prefix:
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Mailing Address - Street 1:880 WOODCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401
Mailing Address - Country:US
Mailing Address - Phone:812-336-5077
Mailing Address - Fax:812-333-6014
Practice Address - Street 1:880 WOODCREST DRIVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401
Practice Address - Country:US
Practice Address - Phone:812-336-5077
Practice Address - Fax:812-333-6014
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01021982A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology