Provider Demographics
NPI:1790950483
Name:VALLOPPILLIL, SURESH JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:JOSEPH
Last Name:VALLOPPILLIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SURESH
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47308-0112
Mailing Address - Country:US
Mailing Address - Phone:800-745-5156
Mailing Address - Fax:
Practice Address - Street 1:5204 SILVER LAKE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7564
Practice Address - Country:US
Practice Address - Phone:214-699-9297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3366207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology