Provider Demographics
NPI:1528104601
Name:SUNTALA, CHRISTOPHER RAY (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:RAY
Last Name:SUNTALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14701 DETROIT
Mailing Address - Street 2:#475
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4182
Mailing Address - Country:US
Mailing Address - Phone:216-221-5650
Mailing Address - Fax:216-221-5659
Practice Address - Street 1:14701 DETROIT
Practice Address - Street 2:#475
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4182
Practice Address - Country:US
Practice Address - Phone:216-221-5650
Practice Address - Fax:216-221-5659
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35050370-S207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0785986Medicaid
OH0785986Medicaid
OHSU0619148Medicare ID - Type Unspecified