Provider Demographics
NPI:1396706545
Name:SUTKOWSKI, PRZEMYSLAW J (MD)
Entity type:Individual
Prefix:
First Name:PRZEMYSLAW
Middle Name:J
Last Name:SUTKOWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 BROOKS LANG
Mailing Address - Street 2:SUITE 285
Mailing Address - City:CLAIRTON
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3747
Mailing Address - Country:US
Mailing Address - Phone:412-469-6956
Mailing Address - Fax:412-469-3799
Practice Address - Street 1:100 DELAFIELD ROAD
Practice Address - Street 2:100-MAB-SUITE 212
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3247
Practice Address - Country:US
Practice Address - Phone:412-784-5144
Practice Address - Fax:412-784-5203
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-02-02
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Provider Licenses
StateLicense IDTaxonomies
PAMD062383L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018306430001Medicaid
PAH27330Medicare UPIN
PA043341MV6Medicare ID - Type Unspecified