Provider Demographics
NPI:1548361801
Name:SARMA, SURESH KUMAR R (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH KUMAR
Middle Name:R
Last Name:SARMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24646 NOVA LN
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2743
Mailing Address - Country:US
Mailing Address - Phone:217-899-8008
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 510396
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33951-0396
Practice Address - Country:US
Practice Address - Phone:217-899-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1061342084P0800X
FL1264122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106134Medicaid
297659000OtherMAGELLAN
FL016683000Medicaid
475532OtherHEALTHLINK
107060OtherHEALTH ALLIANCE
P00301854OtherRR MEDICARE
107060OtherHEALTH ALLIANCE
FL016683000Medicaid