Provider Demographics
NPI:1124260435
Name:SUZELIS, IAN SETH (DO)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:SETH
Last Name:SUZELIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-1643
Mailing Address - Country:US
Mailing Address - Phone:330-235-7445
Mailing Address - Fax:216-201-8034
Practice Address - Street 1:43 W BROAD ST
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1643
Practice Address - Country:US
Practice Address - Phone:330-235-7445
Practice Address - Fax:216-201-8034
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-009428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2919257Medicaid
OH4263701Medicare PIN