Individual
MR. OMPRAKASH N. SUREKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5431 W. STONEBRIDGE CT., PEORIA, IL 61615-2932
(309) 691-8149
Mailing address
5431 W STONEBRIDGE CT, PEORIA, IL 61615-2268
(309) 691-8149
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036-058320
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009035
HEALTH ALLIANCE NUMBER
IL
05
—
036058320
—
IL
01
—
07223459
BCBS OF ILLINOIS
IL
01
—
250004537
RAIL ROAD MEDICARE
IL
01
—
370681567-01
JOHN DEERE PROVIDER NUMBE
IL
Enumeration date
06/17/2006
Last updated
11/25/2014
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