Healthcare Provider Details

I. General information

NPI: 1154309516
Provider Name (Legal Business Name): STEVEN WAYNE SUKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 GRAHAM DR STE 150
TOMBALL TX
77375-3366
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 281-351-5174
  • Fax: 281-351-5172
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-234-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberL3491
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: