Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 55148 | AZ |
N | 111NI0900X | Internist | 55148 | AZ |
N | 207R00000X | Internist | R74538 | AZ |
N | 111NI0900X | Internist | R74538 | AZ |
Y | 207RC0200X | Critical Care Medicine | 88548 | GA |
N | 207RC0200X | Critical Care Medicine | R74538 | AZ |
N | 207RP1001X | Pulmonary Disease | R74538 | AZ |
NPI | 1093120768 |
---|---|
Provider Name | Kawanjit Surapur |
First Address | Tucson, AZ 85724-5040 |
Second Address | Conyers, GA 30012-3877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2014 |
Last Update Date | 28/07/2021 |