Provider Demographics
NPI:1932388980
Name:SURYAM KODALI M.D,.P.A.
Entity Type:Organization
Organization Name:SURYAM KODALI M.D,.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KODALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-777-1141
Mailing Address - Street 1:7737 SOUTHWEST FWY
Mailing Address - Street 2:STE 510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1807
Mailing Address - Country:US
Mailing Address - Phone:713-777-1141
Mailing Address - Fax:
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:STE 510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-777-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURYAM KODALI M.D.,P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2307174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B38GOtherMC/GRP #