Provider Demographics
NPI:1881725836
Name:KARTHIKEYAN, SURIANARAYANAN (MD)
Entity type:Individual
Prefix:DR
First Name:SURIANARAYANAN
Middle Name:
Last Name:KARTHIKEYAN
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 8TH AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4550
Practice Address - Country:US
Practice Address - Phone:701-234-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21916207RG0100X
NY220745-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02151857Medicaid
NY000526402002OtherCOMMUNITY BLUE
NYP040220745OtherBLUE CROSS BLUE SHIELD
NY0004633179OtherAETNA
NY106259BTOtherPREFERRED CARE
NYP010220745OtherBLUE CHOICE
NYP010220745OtherBLUE CHOICE
NY106259BTOtherPREFERRED CARE