Basic Information
| Provider Information | |||||||||
| NPI: | 1225120801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SURAPANENI | ||||||||
| FirstName: | SRI NAVEEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814806264 | ||||||||
| FaxNumber: | 2814804046 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814806264 | ||||||||
| FaxNumber: | 2814804046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/19/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 48602-020 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.