Provider Demographics
NPI:1174591986
Name:SURDACKI, JOSEPH V (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:V
Last Name:SURDACKI
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 1:3032 E HEBRON PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4465
Mailing Address - Country:US
Mailing Address - Phone:972-865-2880
Mailing Address - Fax:972-865-2870
Practice Address - Street 1:3032 E HEBRON PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4465
Practice Address - Country:US
Practice Address - Phone:972-865-2880
Practice Address - Fax:972-865-2870
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6641207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BW943OtherBLUE CROSS
TX955906001OtherCIGNA
TX1209175OtherUNITED HEALTHCARE
TX5517131OtherAETNA
TX955906001OtherCIGNA