Provider Demographics
NPI:1750387056
Name:KAURA, SURINDER MOHAN (MD)
Entity type:Individual
Prefix:DR
First Name:SURINDER
Middle Name:MOHAN
Last Name:KAURA
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 1:6801 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2007
Mailing Address - Country:US
Mailing Address - Phone:313-382-3400
Mailing Address - Fax:313-382-0150
Practice Address - Street 1:6801 ALLEN RD
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2007
Practice Address - Country:US
Practice Address - Phone:313-382-3400
Practice Address - Fax:313-382-0150
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2019-12-06
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
MI4301036001207RA0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4241405-10Medicaid
MI4241405-10Medicaid
MIB43517Medicare UPIN