Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 21645 | AZ |
Y | 2080P0203X | Pediatric Critical Care Doctor | 21645 | AZ |
NPI | 1023065109 |
---|---|
Provider Name | Suresh Lal |
First Address | Phoenix, AZ 85016-8034 |
Second Address | Phoenix, AZ 85008-4973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 14/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
147456 | (05) | AZ |
F91512 | (02) | AZ |