Provider Demographics
NPI:1780962431
Name:SURESH, SUNITHA (MD)
Entity type:Individual
Prefix:DR
First Name:SUNITHA
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUNITHA
Other - Middle Name:DESIKAN
Other - Last Name:SURESH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:509-572-1826
Mailing Address - Fax:623-552-3320
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4707
Practice Address - Country:US
Practice Address - Phone:480-412-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60226533207R00000X
WAMD 60226533207RI0200X
AZ31640207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1780962431Medicaid
WA0287422OtherLABOR & INDUSTRIES
AZ797194Medicaid