Provider Demographics
NPI:1154577831
Name:SUTTER MEDICAL GROUP OF THE REDWOODS
Entity type:Organization
Organization Name:SUTTER MEDICAL GROUP OF THE REDWOODS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEVENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:707-521-8879
Mailing Address - Street 1:3883 AIRWAY DR
Mailing Address - Street 2:300
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1671
Mailing Address - Country:US
Mailing Address - Phone:707-303-8310
Mailing Address - Fax:707-545-0823
Practice Address - Street 1:500 DOYLE PARK D.
Practice Address - Street 2:200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-521-8809
Practice Address - Fax:707-521-8835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty