Provider Demographics
NPI:1720071244
Name:NARAYANAN, SURESH K (MD)
Entity Type:Individual
Prefix:
First Name:SURESH
Middle Name:K
Last Name:NARAYANAN
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 1:11125 DUNN RD
Mailing Address - Street 2:STE 204
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6132
Mailing Address - Country:US
Mailing Address - Phone:314-839-5522
Mailing Address - Fax:314-839-5351
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:STE 204
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6132
Practice Address - Country:US
Practice Address - Phone:314-839-5522
Practice Address - Fax:314-839-5351
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115543207RC0000X
IL036105940207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2501038OtherUHC
6415380002OtherCIGNA
467659OtherHLNK
27050OtherBLCHOICE
102409V3831OtherGHP
MO150973OtherMOBS
MO205721301Medicaid
24852V8816OtherHCUSA
7674277OtherAETNA
MO060065774OtherMORRMCR
IL060067891OtherILRRMCR
V30946OtherHLTHPART
G43207OtherMERCY
467659OtherHLNK
ILL89420Medicare PIN
MO008010900Medicare PIN
MO008010452Medicare PIN
MO006011207Medicare PIN
ILL89419Medicare PIN
6415380002OtherCIGNA