Healthcare Provider Details

I. General information

NPI: 1891233219
Provider Name (Legal Business Name): SUZ M.D. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11946 SKYLAKE PL UNIT D
TEMPLE TERRACE FL
33617-1623
US

IV. Provider business mailing address

11808 N 56TH ST
TEMPLE TERRACE FL
33617-1536
US

V. Phone/Fax

Practice location:
  • Phone: 813-838-1369
  • Fax:
Mailing address:
  • Phone: 813-838-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUZANNE A. SALHAB
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 813-838-1369