Provider Demographics
NPI:1205915147
Name:PHILIP, SURESH (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:PHILIP
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 1:7525 W DESCHUSTES PL
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336
Mailing Address - Country:US
Mailing Address - Phone:509-737-8766
Mailing Address - Fax:509-737-8887
Practice Address - Street 1:7525 W DESCHUSTES PL
Practice Address - Street 2:SUITE 1A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336
Practice Address - Country:US
Practice Address - Phone:509-737-8766
Practice Address - Fax:509-737-8887
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00042832207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8800113OtherMEDICARE
WAH98357Medicare UPIN