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NPI Code Detail

MEDICARE: TROY SUWONDO

MEDICARE: TROY SUWONDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramNE

General Provider Information

NPI Number : 1578405189
Entity Type Code : Individual
Provider Name (Legal Business Name) : TROY SUWONDO
Provider Business Mailing Address
First Line : 1319 LEAVENWORTH ST
Second Line :
City : OMAHA
State : NE
Zip : 68102-3215
Country : US
Telephone Number : 402-552-2050
Fax Number : 402-552-2172
Provider Business Practice Location Address
First Line : 1319 LEAVENWORTH ST
Second Line :
City : OMAHA
State : NE
Zip : 68102-3215
Country : US
Telephone Number : 402-552-2050
Fax Number : 402-552-2172
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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Directions to “ TROY SUWONDO ” Practice Location

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