Healthcare Provider Details

I. General information

NPI: 1598765422
Provider Name (Legal Business Name): SUTANU MISRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 W BROWARD BLVD
PLANTATION FL
33324-2701
US

IV. Provider business mailing address

4444 ARABIAN WAY
COOPER CITY FL
33328-2802
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-6600
  • Fax:
Mailing address:
  • Phone: 724-831-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME126867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: