Provider Demographics
NPI:1942402961
Name:SURESH, DEEPA (MD)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6300 WEST LOOP S STE 290
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2913
Mailing Address - Country:US
Mailing Address - Phone:832-702-3435
Mailing Address - Fax:713-930-9517
Practice Address - Street 1:6300 WEST LOOP S STE 290
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2913
Practice Address - Country:US
Practice Address - Phone:832-702-3435
Practice Address - Fax:713-930-9517
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN41412080P0205X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB110704Medicare PIN