Individual
MS. ANUSHA SURENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1715 DOUSMAN ST, GREEN BAY, WI 54303-3211
(920) 496-4700
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301105985
MI
207R00000X
Internal Medicine Physician
Primary
66784-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
4301105985
MI
Other
Enumeration date
06/26/2014
Last updated
07/21/2022
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