1164436523 NPI number — DR. RONALD S SUH M.D.

Table of content: DR. RONALD S SUH M.D. (NPI 1164436523)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164436523 NPI number — DR. RONALD S SUH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUH
Provider First Name:
RONALD
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164436523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
679 E COUNTY LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46143-1049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-807-1262
Provider Business Mailing Address Fax Number:
317-859-4268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 AVON MARKETPLACE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46123-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-890-2000
Provider Business Practice Location Address Fax Number:
317-671-8033
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  01060497A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100194370 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200288740 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1487680518 . This is a "GROUP NPI" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000366998 . This is a "ANTHEM PIN NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00260933 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200523730 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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