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General NPI Number Information
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NPI Number | 1609815216
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Entity Type | Individual
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Provider Name | LEONAS PRANAS SULAS MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 11/29/2007
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Provider Practice Location Address
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Address Line | 2817 NEW PINERY ROAD DIVINE SAVIOR HEALTHCARE
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City | PORTAGE
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State | WI
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Zip | 53901-0387
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Country | US
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Telephone | 608-745-5603
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Fax | 608-742-6098
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Provider Business Mailing Address
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Address Line | 2817 NEW PINERY ROAD, PO BOX 387 DIVINE SAVIOR HEALTHCARE
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City | PORTAGE
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State | WI
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Zip | 53901-0387
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Country | US
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Telephone | 608-745-5603
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Fax | 608-742-6098
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 27361020
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License Number State | WI
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