Surdy, Theodore

Surdy, Theodore is an individual health care provider with primary practice located at 1227 Caledonia St , Mankato MN 56001-4329. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Surdy, Theodore can be contacted via phone (507) 388-8874.

Contact Information

Primary practice address
1227 Caledonia St Mankato MN 56001-4329
Phone: (507) 388-8874
Fax: (507) 685-4807
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X LP3385 Minnesota

Profile Details

NPI number 1063463347
LBN Legal business name Surdy, Theodore
Credentials PHD LP
Entity Individual
Sole proprietor 1 No
Enumeration date May 12th, 2006
Last updated Mar 16th, 2023 - about last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063463347 NPPES
Minnesota Other 06T04SU BXBS
Minnesota Other 114945 BXBS
Minnesota Other 114945 BXBS
Minnesota MEDICAID 497823400 BXBS
Minnesota Other HP28628 BXBS

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