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General NPI Number Information
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NPI Number | 1669675153
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Entity Type | Individual
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Provider Name | MU SU MD
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 13001 SOUTHERN BLVD
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9203
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Country | US
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Telephone | 561-798-6035
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Fax | 561-753-4298
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Provider Business Mailing Address
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Address Line | PO BOX 741087
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City | ATLANTA
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State | GA
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Zip | 30384-1087
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Country | US
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Telephone | 561-798-6036
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Fax | 561-753-4298
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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 | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | ME 109094
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ZH0000X
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Taxonomy Name | Hematology (Pathology) Physician
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License Number | ME 109094
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME 109094
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License Number State | FL
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