Organization
SURESH KANKANALA M.D, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SURESH BABU KANKANALA M.D (PRESIDENT)
(972) 544-6600
Entity
Organization
Contact information
Practice address
923 COLLEGE AVE, SUITE 103, FORT WORTH, TX 76104-3050
(972) 544-6600
Mailing address
923 COLLEGE AVE, SUITE 103, FORT WORTH, TX 76104-3050
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
Primary
N5145
TX
282N00000X
General Acute Care Hospital
N5145
TX
Other
Enumeration date
06/28/2016
Last updated
08/08/2016
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