Healthcare Provider Details

I. General information

NPI: 1972614683
Provider Name (Legal Business Name): THOMAS L SUTTER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N. ANTHONY DRIVE OCCUPATIONAL MEDICINE
URBANA IL
61801
US

IV. Provider business mailing address

P.O. BOX 6002
URBANA IL
61803-6002
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3229
  • Fax:
Mailing address:
  • Phone: 217-326-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number036073649
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: