Provider Demographics
NPI:1336465061
Name:MANICKAVEL, SURESH KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SURESH KUMAR
Middle Name:
Last Name:MANICKAVEL
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 1:1801 NW 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1101
Mailing Address - Country:US
Mailing Address - Phone:305-355-5000
Mailing Address - Fax:305-355-5797
Practice Address - Street 1:1801 NW 9TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1101
Practice Address - Country:US
Practice Address - Phone:305-355-5000
Practice Address - Fax:305-355-5797
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018010170207R00000X, 207RC0200X
FLME134191207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine