Provider Demographics
NPI:1083685572
Name:SUTTON, DAVID A (PA - C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:SUTTON
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 ROLLINGRIDGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4231
Mailing Address - Country:US
Mailing Address - Phone:630-967-6000
Mailing Address - Fax:630-428-3971
Practice Address - Street 1:2940 ROLLINGRIDGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-4231
Practice Address - Country:US
Practice Address - Phone:630-967-6000
Practice Address - Fax:630-428-3971
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970025829OtherRAILROAD MEDICARE
200974Medicare ID - Type Unspecified
P30775Medicare UPIN