Provider Demographics
NPI:1922218676
Name:RODIL, SURESH JACOB (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH
Middle Name:JACOB
Last Name:RODIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9229 LBJ FWY
Mailing Address - Street 2:STE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3405
Mailing Address - Country:US
Mailing Address - Phone:800-346-0747
Mailing Address - Fax:972-739-2638
Practice Address - Street 1:3100 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0436
Practice Address - Country:US
Practice Address - Phone:972-915-3600
Practice Address - Fax:972-915-3636
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV13224207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS18185OtherPHARMACY
NV13224OtherNV MEDICAL LICENSE
MI4301088266OtherMI MEDICAL LICENSE
MI4301088266OtherMI MEDICAL LICENSE
NVCJ245ZMedicare PIN
MIFR1387198OtherDEA