| Doctor Name: | SURJIT THIARA |
| NPI Number: | 1609856715 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 036073740 |
| Business Practice Address: | 915 N Caron Rd Rochelle, IL - 610689649 |
| Business Phone Number: | 8155624014 |
| Business Fax Number: | |
| Mailing Address: | Po Box 418, ROCHELLE |
| State: | IL |
| Postal Code: | 610680418 |
| Phone Number: | 8156547772 |
| Fax Number: | 8156547009 |
| NPI Enumeration Date: | 01/17/2006 |
| NPI Last Update Date: | 07/16/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 036073740 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |