Provider Demographics
NPI:1023426947
Name:SURESH SUREDDI MD LLC
Entity type:Organization
Organization Name:SURESH SUREDDI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUREDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-908-1255
Mailing Address - Street 1:BOX 213, 120 E. FM 544
Mailing Address - Street 2:72
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4035
Mailing Address - Country:US
Mailing Address - Phone:214-908-1255
Mailing Address - Fax:888-393-5982
Practice Address - Street 1:730 E PARK BLVD
Practice Address - Street 2:120
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-5451
Practice Address - Country:US
Practice Address - Phone:214-908-1255
Practice Address - Fax:888-393-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty