Provider Demographics
NPI:1134186471
Name:K.R. SURESH PHYSICIANS, LLC
Entity type:Organization
Organization Name:K.R. SURESH PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEELAPANDAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SURESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-333-8322
Mailing Address - Street 1:21851 CENTER RIDGE RD
Mailing Address - Street 2:309
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3976
Mailing Address - Country:US
Mailing Address - Phone:440-333-8322
Mailing Address - Fax:440-333-3180
Practice Address - Street 1:21851 CENTER RIDGE RD
Practice Address - Street 2:309
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3976
Practice Address - Country:US
Practice Address - Phone:440-333-8322
Practice Address - Fax:440-333-3180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1543370207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2594661Medicaid
OH9354591Medicare ID - Type UnspecifiedGROUP NUMBER