Provider Demographics
NPI:1710174172
Name:SURYANARAYANA, PRAKASH GOUTHAM BELEYUR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH GOUTHAM
Middle Name:BELEYUR
Last Name:SURYANARAYANA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2080 OAKLEY SEAVER DR STE 130
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1962
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:407-650-1307
Practice Address - Street 1:2080 OAKLEY SEAVER DR STE 130
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1962
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:407-650-1307
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2024-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD88499207RC0001X
FLME153140207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113482600Medicaid