Provider Demographics
NPI:1831142777
Name:SURI, VIKAS (RPT)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:
Last Name:SURI
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23829 LITTLE MACK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1186
Mailing Address - Country:US
Mailing Address - Phone:586-773-1300
Mailing Address - Fax:586-773-1600
Practice Address - Street 1:45441 HEYDENREICH RD
Practice Address - Street 2:
Practice Address - City:MACOMB TWP
Practice Address - State:MI
Practice Address - Zip Code:48044-6602
Practice Address - Country:US
Practice Address - Phone:586-416-1300
Practice Address - Fax:586-416-0867
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009890225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H26204013Medicare ID - Type Unspecified
MIQ61281Medicare UPIN