| Suresh C Mishra Mdpa | |
|
3332 17th St Sarasota FL 34235-8904 | |
| (941) 365-2171 | |
| (941) 957-3349 |
| Full Name | Suresh C Mishra Mdpa |
|---|---|
| Speciality | Family Medicine |
| Location | 3332 17th St, Sarasota, Florida |
| Authorized Official Name and Position | Suresh C Mishra (PRESIDENT) |
| Authorized Official Contact | 9413652171 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suresh C Mishra Mdpa 3332 17th St Sarasota FL 34235-8904 Ph: (941) 365-2171 | Suresh C Mishra Mdpa 3332 17th St Sarasota FL 34235-8904 Ph: (941) 365-2171 |
| NPI Number | 1194025791 |
|---|---|
| Provider Enumeration Date | 10/28/2010 |
| Last Update Date | 10/28/2010 |
| Medicare PECOS PAC ID | 4082898242 |
|---|---|
| Medicare Enrollment ID | O20110412000955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194025791 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME 54969 (Florida) | Primary |
| Provider Name | Suresh Mishra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720011687 PECOS PAC ID: 4981888146 Enrollment ID: I20110412000973 |
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