Surdam, Jonathan W
Surdam, Jonathan W is an individual health care provider with primary practice located at 1302 S Rogers St , Bloomington IN 47403-4752. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Surdam, Jonathan W can be contacted via phone (812) 333-2663.Contact Information
Primary practice address
1302 S Rogers St
Bloomington IN 47403-4752
Phone: (812) 333-2663
Fax: (812) 676-4131
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 01058877 | Indiana |
Profile Details
| NPI number | 1124009287 |
|---|---|
| LBN Legal business name | Surdam, Jonathan W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 7th, 2005 |
| Last updated | Dec 23rd, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124009287 | NPPES |
| Indiana | Other | P00146258 | RAILROAD MEDICARE |
| Indiana | MEDICAID | 200479570 | RAILROAD MEDICARE |
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