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General NPI Number Information
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NPI Number | 1821277666
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Entity Type | Organization
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Legal Business Name | MIDWEST DERMATOLOGY INCORPORATED PC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 8855 E RENO AVENUE SUITE 200
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City | MIDWEST CITY
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State | OK
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Zip | 73110-7724
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Country | US
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Telephone | 405-737-8877
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Fax | 405-737-4780
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Provider Business Mailing Address
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Address Line | 8855 E RENO AVENUE SUITE 200
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City | MIDWEST CITY
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State | OK
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Zip | 73110-7530
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Country | US
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Telephone | 405-737-8877
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Fax | 405-737-4780
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN H SUTTER
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Credential | MD
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Telephone | 405-737-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 18006
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License Number State | OK
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