Provider Demographics
NPI:1922164573
Name:SURESH, B S (MD)
Entity Type:Individual
Prefix:DR
First Name:B
Middle Name:S
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 1:1751 W ROMNEYA DR
Mailing Address - Street 2:SUITE #J
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1815
Mailing Address - Country:US
Mailing Address - Phone:714-776-3566
Mailing Address - Fax:714-776-3303
Practice Address - Street 1:1751 W ROMNEYA DR
Practice Address - Street 2:SUITE #J
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1815
Practice Address - Country:US
Practice Address - Phone:714-776-3566
Practice Address - Fax:714-776-3303
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA458202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101430Medicaid
A45820OtherMEDICARE
CA00A458200Medicaid
A45820OtherMEDICARE
F51447Medicare UPIN
W19093Medicare ID - Type UnspecifiedMEDICARE - GROUP