Provider Demographics
NPI:1710911334
Name:BEDI, SURMEET
Entity Type:Individual
Prefix:
First Name:SURMEET
Middle Name:
Last Name:BEDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:# L3439
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:937-383-2700
Mailing Address - Fax:
Practice Address - Street 1:630 W MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2170
Practice Address - Country:US
Practice Address - Phone:937-383-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1851207R00000X
OH91836207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2939815Medicaid
OH4248292Medicare PIN