SURYA MEDICAL GROUP SC (NPI# 1043415631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043415631 |
| Entity Type | Organization |
| Organization Name | SURYA MEDICAL GROUP SC |
| Practice Address |
6125 Green Bay Rd Suite 100 Kenosha WI 53142-2928 |
| Practice Telephone | 2625648636 |
| Mailing Telephone | 2625648636 |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2007-10-05 |
| Authorized Official Name | GANESH N PULLA (DOCTOR) |
| Authorized Official Telephone | 2625648636 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians | ||
| Y | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21279800 | 05 |
| Street Address |
6125 GREEN BAY RD SUITE 100 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53142-2928 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730155573 | Victor Stephen Slana | Ophthalmology | 6125 Green Bay Rd, Ste 800, Kenosha, WI 53142-2928 | 2006-02-23 |
| 1144493792 | Laurie Ann Robertson | Optometrist | 6125 Green Bay Rd, Suite 800, Kenosha, WI 53142-2928 | 2008-04-03 |
| 1720283302 | Kidney Replacement Therapies, Sc | Clinic/Center | 6125 Green Bay Rd, Suite 100, Kenosha, WI 53142-2928 | 2007-06-15 |
| 1730219924 | Kenosha Kidney Dialysis LLC | Clinic/Center | 6125 Green Bay Rd, Suite 100, Kenosha, WI 53142-2942 | 2007-03-06 |
| 1295876647 | Frank Serrecchia | Pediatrics | 6125 Green Bay Rd, Suite 700, Kenosha, WI 53142-2928 | 2007-02-09 |
| 1295887321 | V. Stephen Slana, M.d.,s.c. | Durable Medical Equipment & Medical Supplies | 6125 Green Bay Rd, Suite 800, Kenosha, WI 53142-2928 | 2007-01-17 |
| 1962559302 | Bharathi Pulla | Family Medicine | 6125 Green Bay Rd, Kenosha, WI 53142-2928 | 2007-01-05 |
| 1679620918 | Ganesh N Pulla | Internal Medicine | 6125 Green Bay Rd, 100, Kenosha, WI 53142-2928 | 2007-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297816 | Caring Hearts Home Health Care | In Home Supportive Care | 6021-57th Ave, Suite C103, Kenosha, WI 53142 | 2020-02-14 |
| 1144785395 | Michael L Wrzesinski | Counselor | 4109 67th Street, Kenosha, WI 53142 | 2019-02-01 |
| 1720538499 | David Smith | Counselor | 10900 67th Street, Kenosha, WI 53142 | 2016-10-06 |
| 1326404641 | Smile Doctors Ltd | Dentist | 7003 39th Ave, Kenosha, WI 53142 | 2016-01-04 |
| 1225409485 | Antonia Marie Decker | Physician Assistant | 10400 75th St. Ste 204, Kenosha, WI 53142 | 2015-10-14 |
| 1780060582 | Joshua Haas | Pharmacist | 7701 Green Bay Road, Kenosha, IL 53142 | 2015-08-04 |
| 1811379225 | Dana Mary Stout | Registered Nurse | 7401 104th Avenue, Suite 110, Comprehensive Orthopaedics, S.c., Kenosha, WI 53142 | 2015-06-22 |
| 1669815569 | Joshua Knute Elson | Radiology | 6811 118th Ave, Kenosha, WI 53142 | 2013-04-10 |
| 1356610166 | Michael J Gallo | Pharmacist | 7535 North Greenbay Rd, Kenosha, WI 53142 | 2011-12-22 |
| 1720357999 | Orest Carnevale | Registered Nurse | 7316 155th Ct, Kenosha, WI 53142 | 2011-12-18 |
| Find all providers in zip 53142 | ||||
| Taxonomy Code | 207QG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Geriatric Medicine |
| A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://wwwtheabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710486121 | Integrity Senior Health | Family Medicine | 4347 Danbury Ln, Mount Pleasant, WI 53403-4022 | 2018-02-12 |
| 1508075409 | Jonny Alexander Macias Tejada | Family Medicine | 1020 N 12th St Ste 301, Milwaukee, WI 53233-1308 | 2007-05-21 |
| 1902907454 | Michael Lee Douglas | Family Medicine | 1110 Bergslien Street, Baldwin, WI 54002 | 2006-09-26 |
| 1801888938 | Mary C Ball | Family Medicine | 100 Silverado Dr, Stoughton, WI 53589-5406 | 2005-08-16 |
| 1790312171 | Sequoia Integrative Medical Services LLC | Family Medicine | 1351 Ontario Rd, Green Bay, WI 54311-8302 | 2020-03-25 |
| 1275174922 | Leslie Ann Las | Family Medicine | 500 East Veterans Street, Tomah, WI 54660 | 2019-10-03 |
| 1558795914 | Richard London, M.d., L.L.C. | Family Medicine | 5000 W Chambers St, Milwaukee, WI 53210-1650 | 2013-08-21 |
| 1255518437 | Galia Paganelli | Family Medicine | 800 West Ave S, La Crosse, WI 54601-8806 | 2008-01-30 |
| 1235349077 | Ellen Turner Wenberg | Family Medicine | 710 Riverside Dr, Waupaca, WI 54981-1941 | 2007-05-23 |
| 1295952208 | Michael Stephen Garrity | Family Medicine | 916 Ferry St, La Crosse, WI 54601-4717 | 2007-04-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.