Provider Demographics
NPI:1366418014
Name:SUAU, LUIS J (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:J
Last Name:SUAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CALLE MEDITACION
Mailing Address - Street 2:OFICINA 2A
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4882
Mailing Address - Country:US
Mailing Address - Phone:787-833-0610
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE MEDITACION
Practice Address - Street 2:OFICINA 2A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4882
Practice Address - Country:US
Practice Address - Phone:787-833-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3841207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C78113Medicare UPIN
95197Medicare ID - Type Unspecified