MEDICARE: DR. VINCENT P SUSTERSIC D.O.

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
1	207Q00000X	Family Medicine Physician	34003327	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851329825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT P SUSTERSIC D.O.

Provider Business Mailing Address
First Line	:	2624 HIDDEN CANYON DR
Second Line	:
City	:	BRECKSVILLE
State	:	OH
Zip	:	44141-3531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 E ROYALTON RD STE 2600
Second Line	:
City	:	BROADVIEW HTS
State	:	OH
Zip	:	44147-3532
Country	:	US
Telephone Number	:	216-524-8883
Fax Number	:	216-524-2125

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	01/15/2021

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