OrganizationActive
Surya Medical Group Sc
NPI 1043415631 · Geriatric Medicine (Family Medicine) Physician · Kenosha, WI
Provider details
- NPI number
- 1043415631
- Entity type
- Organization
- Primary specialty
- Geriatric Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Ganesh Pulla, Doctor(262) 564-8636
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Nephrology Physician207RN0300X
Allopathic & Osteopathic Physicians
Practice location
6125 Green Bay Rd
Suite 100
Kenosha, WI 53142-2928
Phone: (262) 564-8636
Approximate (ZIP-level) locationGet directions
Mailing address
6125 Green Bay Rd
Kenosha, WI 53142-2928
Registry dates
- Enumerated
- 2007-06-15
- Last updated
- 2007-10-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.