SURYA MEDICAL GROUP SC NPI 1043415631

NPI Information

SURYA MEDICAL GROUP SC is a geriatric medicine family medicine in Kenosha, WI. The provider is a family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. SURYA MEDICAL GROUP SC NPI is 1043415631. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

6125 GREEN BAY RD
SUITE 100
KENOSHA, WI
ZIP 53142-928
Phone: (262) 564-8636

The provider's authorized official is Ganesh N Pulla .
The authorized official title is Doctor and has the following contact phone number (262) 564-8636.

The CLIA number assigned to this NPI record is 52D0985952 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/15/2007 and was last updated on 10/5/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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