Basic Information
| Provider Information | |||||||||
| NPI: | 1548361801 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SARMA | ||||||||
| FirstName: | SURESH KUMAR | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24646 NOVA LN | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339802743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178998008 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 733 E OLYMPIA AVE | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9418331750 | ||||||||
| FaxNumber: | 9417661511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 126412 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 036-106134 | IL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 036106134 | 05 | IL | MEDICAID | 016683000 | 05 | FL | MEDICAID | P00301854 | 01 | RR MEDICARE | OTHER | 107060 | 01 | HEALTH ALLIANCE | OTHER | 297659000 | 01 | MAGELLAN | OTHER | 475532 | 01 | HEALTHLINK | OTHER |