Provider Demographics
NPI:1598129702
Name:SURESH, SANDIP (MD)
Entity type:Individual
Prefix:
First Name:SANDIP
Middle Name:
Last Name:SURESH
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:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-697-5971
Mailing Address - Fax:281-595-1499
Practice Address - Street 1:905 W MEDICAL CENTER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4009
Practice Address - Country:US
Practice Address - Phone:281-697-5971
Practice Address - Fax:281-595-1499
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMD1983604207W00000X
TXT0948207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX423325602Medicaid