Healthcare Provider Details

I. General information

NPI: 1346263001
Provider Name (Legal Business Name): LOWELL SUCKOW M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 MARYSVILLE BLVD
SACRAMENTO CA
95838-4512
US

IV. Provider business mailing address

3441 MARYSVILLE BLVD
SACRAMENTO CA
95838-4512
US

V. Phone/Fax

Practice location:
  • Phone: 916-563-7230
  • Fax: 916-563-7229
Mailing address:
  • Phone: 916-563-7230
  • Fax: 916-563-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG37291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: