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Contact Information

SURYA MEDICAL GROUP SC
6125 GREEN BAY RD
SUITE 100
KENOSHA, WI53142-2928
 Phone: 262-564-8636
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Geriatric Medicine

207QG0300X 08 Physician/Family Practice
 

Nephrology

207RN0300X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for SURYA MEDICAL GROUP SC

NPI Number 1043415631
LBN Legal business name SURYA MEDICAL GROUP SC
Authorized official GANESH PULLA - (DOCTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 06/15/2007
Last updated 10/05/2007 - About 19 years ago
Identifiers
WI Medicaid 21279800
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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