Basic Information
Provider Information
NPI: 1497167266
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SURESH
FirstName: RAHUL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11511 SHADOW CREEK PKWY
Address2:  
City: PEARLAND
State: TX
PostalCode: 775847298
CountryCode: US
TelephoneNumber: 7134424997
FaxNumber:  
Practice Location
Address1: 301 UNIVERSITY BLVD
Address2:  
City: GALVESTON
State: TX
PostalCode: 775550570
CountryCode: US
TelephoneNumber: 4097727063
FaxNumber: 4097478579
Other Information
ProviderEnumerationDate: 05/28/2014
LastUpdateDate: 08/23/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/23/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XR6687TXN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000XR6687TXY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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