Healthcare Provider Details

I. General information

NPI: 1720519184
Provider Name (Legal Business Name): BRIAN SUTTERER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 S MOUNT AUBURN RD STE 101
CAPE GIRARDEAU MO
63703-4940
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 573-519-4960
  • Fax: 573-519-4655
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number64254
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number64254
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: