Provider Demographics
NPI:1235683699
Name:ALUMPARAMBIL SURENDRAN, SREERAG (MD)
Entity type:Individual
Prefix:
First Name:SREERAG
Middle Name:
Last Name:ALUMPARAMBIL SURENDRAN
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 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5702
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:20000 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6805
Practice Address - Country:US
Practice Address - Phone:216-491-7036
Practice Address - Fax:216-491-7776
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI70545-20207R00000X
TXBP10057160207R00000X
OH35.150057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine