Provider Demographics
NPI:1760440374
Name:SURESH, KEELAPANDAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:KEELAPANDAL
Middle Name:R
Last Name:SURESH
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 1:21245 LORAIN RD
Mailing Address - Street 2:STE 206
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2140
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:309
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3976
Practice Address - Country:US
Practice Address - Phone:440-333-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059258207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000543804OtherANTHEM
9273172OtherMEDICARE PHYSICIAN GROUP
OH0880917Medicaid
000000543804OtherANTHEM
9273172OtherMEDICARE PHYSICIAN GROUP