Provider Demographics
NPI:1851382857
Name:NUCHIKAT, P SURESH (MD)
Entity Type:Individual
Prefix:DR
First Name:P SURESH
Middle Name:
Last Name:NUCHIKAT
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 1:2600 TUSCARAWAS ST W #160
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4696
Mailing Address - Country:US
Mailing Address - Phone:330-454-9126
Mailing Address - Fax:330-454-9470
Practice Address - Street 1:2600 TUSCARAWAS ST W #160
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4696
Practice Address - Country:US
Practice Address - Phone:330-454-9126
Practice Address - Fax:330-454-9470
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3535026207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0250320Medicaid
OH0250320Medicaid
0401144Medicare PIN