Provider Demographics
NPI:1104187632
Name:SULEK, JAY EDMUND (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:EDMUND
Last Name:SULEK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2801 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4035
Mailing Address - Country:US
Mailing Address - Phone:615-250-9200
Mailing Address - Fax:615-250-9251
Practice Address - Street 1:1420 W BADDOUR PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-443-0202
Practice Address - Fax:615-449-8708
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2018-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN57371208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN57371OtherLICENSE