Healthcare Provider Details

I. General information

NPI: 1215446455
Provider Name (Legal Business Name): ANTOINE SUGGS CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 SHAKER DR
LEXINGTON KY
40504-3745
US

IV. Provider business mailing address

750 SHAKER DR APT 303
LEXINGTON KY
40504-3726
US

V. Phone/Fax

Practice location:
  • Phone: 859-552-1569
  • Fax:
Mailing address:
  • Phone: 859-552-1569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: