Provider Demographics
NPI:1528125192
Name:NAIK, SURESH R (MD)
Entity type:Individual
Prefix:DR
First Name:SURESH
Middle Name:R
Last Name:NAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3535 30TH AVENUE
Mailing Address - Street 2:SUITE #207 SURESH R NAIK MD SC
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20553207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31103000Medicaid
WI31103000Medicaid
WI000032457Medicare PIN
B85100Medicare UPIN