Provider Demographics
NPI:1750581880
Name:CHRISTOPHER L. SUREK, D.O. APMC
Entity type:Organization
Organization Name:CHRISTOPHER L. SUREK, D.O. APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SUREK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:225-658-1960
Mailing Address - Street 1:6110 MAIN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4033
Mailing Address - Country:US
Mailing Address - Phone:225-658-1960
Mailing Address - Fax:225-658-1920
Practice Address - Street 1:6110 MAIN ST
Practice Address - Street 2:SUITE D
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4033
Practice Address - Country:US
Practice Address - Phone:225-658-1960
Practice Address - Fax:225-658-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO000011207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1750581880OtherGROUP NPI
LA1336119858OtherINDIVIDUAL NPI
LA1625965Medicaid