Healthcare Provider Details

I. General information

NPI: 1326092453
Provider Name (Legal Business Name): ANGELA C SUKSTORF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA C REMINGTON MD

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-2303
US

IV. Provider business mailing address

2540 N HEALTHY WAY
FREMONT NE
68025-2315
US

V. Phone/Fax

Practice location:
  • Phone: 402-941-1359
  • Fax:
Mailing address:
  • Phone: 402-727-1091
  • Fax: 402-727-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number22674
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: