Provider Demographics
NPI:1215462213
Name:JANDE, SURAJ SINGH (MD)
Entity type:Individual
Prefix:MR
First Name:SURAJ
Middle Name:SINGH
Last Name:JANDE
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 1:1535 RIVER PARKWAY BLVD APT 910
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-1821
Mailing Address - Country:US
Mailing Address - Phone:973-980-3784
Mailing Address - Fax:973-877-5767
Practice Address - Street 1:1541 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-626-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2021-01-26
Deactivation Date:2017-11-29
Deactivation Code:
Reactivation Date:2020-01-27
Provider Licenses
StateLicense IDTaxonomies
LA324371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine