Basic Information
| Provider Information | |||||||||
| NPI: | 1942279880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VEERAMACHANENI | ||||||||
| FirstName: | SURESH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15090 | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928035090 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147718000 | ||||||||
| FaxNumber: | 7149377083 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 W STEWART DR STE 3205 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147718000 | ||||||||
| FaxNumber: | 7149377083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 06/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | A74669 | CA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | A74669 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1912919804 | 01 | CA | NPI - TYPE 2 | OTHER | A74669 | 01 | CA | STATE MEDICAL LICENSE (SINCE 5/2001) | OTHER | 1447427018 | 01 | AZ | NPI - TYPE 2 | OTHER | 43237 | 01 | AZ | STATE MEDICAL LICENSE (SINCE 8/2010) | OTHER | 568683 | 05 | AZ | MEDICAID |