Provider Demographics
NPI:1528249687
Name:SUKSANONG AND SUKSANONG MDS PA
Entity type:Organization
Organization Name:SUKSANONG AND SUKSANONG MDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MINGQUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKSANONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-823-7224
Mailing Address - Street 1:PO BOX 1945
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34682-1945
Mailing Address - Country:US
Mailing Address - Phone:727-771-1300
Mailing Address - Fax:727-781-2300
Practice Address - Street 1:1752 MLK JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33704-4206
Practice Address - Country:US
Practice Address - Phone:727-823-7224
Practice Address - Fax:727-489-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31666207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDQ8992OtherRR MEDICARE
FLDH807AMedicare PIN