Healthcare Provider Details

I. General information

NPI: 1972616746
Provider Name (Legal Business Name): DENNIS SUICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 E BROADWAY SUITE 200
COLUMBIA MO
65201-8023
US

IV. Provider business mailing address

670 MASON RIDGE CENTER DR SUITE 300
SAINT LOUIS MO
63141-8573
US

V. Phone/Fax

Practice location:
  • Phone: 573-815-7119
  • Fax: 573-815-7116
Mailing address:
  • Phone: 314-996-7644
  • Fax: 314-996-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number101237
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: