Provider Demographics
NPI:1881861953
Name:SURRAJ MEDICAL ASSOCIATES,PLLC
Entity type:Organization
Organization Name:SURRAJ MEDICAL ASSOCIATES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:SACHDEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-249-2100
Mailing Address - Street 1:9401 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4233
Mailing Address - Country:US
Mailing Address - Phone:623-249-2100
Mailing Address - Fax:623-476-7305
Practice Address - Street 1:9401 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 155
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4233
Practice Address - Country:US
Practice Address - Phone:623-249-2100
Practice Address - Fax:623-476-7305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35075261QM2500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ461157Medicaid
AZH39750Medicare UPIN
AZ461157Medicaid