Provider Demographics
NPI:1710932561
Name:SUREDDI, SURESH (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:
Last Name:SUREDDI
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 828
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8144
Mailing Address - Country:US
Mailing Address - Phone:972-562-0190
Mailing Address - Fax:972-563-3647
Practice Address - Street 1:3920 ALMA DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-6748
Practice Address - Country:US
Practice Address - Phone:972-422-5939
Practice Address - Fax:972-424-2382
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK42562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105713504Medicaid
TXD35328Medicare UPIN