Provider Demographics
NPI:1194923045
Name:SURESH R NAIKMD SC
Entity type:Organization
Organization Name:SURESH R NAIKMD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:NAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD SC
Authorized Official - Phone:262-658-1618
Mailing Address - Street 1:3535 30TH AVENUE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144
Mailing Address - Country:US
Mailing Address - Phone:262-658-1618
Mailing Address - Fax:262-654-4562
Practice Address - Street 1:3535 30TH AVENUE
Practice Address - Street 2:#207 SURESH R NAIK MD SC
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144
Practice Address - Country:US
Practice Address - Phone:262-658-1618
Practice Address - Fax:262-654-4562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31103000Medicaid
B85100Medicare UPIN