Provider Demographics
NPI:1588869119
Name:SUTKUS, AMY (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SUTKUS
Suffix:
Gender:F
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:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:MILL CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97360-0047
Mailing Address - Country:US
Mailing Address - Phone:503-897-4100
Mailing Address - Fax:503-897-2673
Practice Address - Street 1:280 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MILL CITY
Practice Address - State:OR
Practice Address - Zip Code:97360-2324
Practice Address - Country:US
Practice Address - Phone:503-897-4100
Practice Address - Fax:503-897-2673
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD29295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine