MEDICARE: DR. STEVEN J SUKSTORF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician	ME47793	FL
2	2085N0904X	Nuclear Radiology Physician	ME47793	FL
3	2085P0229X	Pediatric Radiology Physician	ME47793	FL
4	2085U0001X	Diagnostic Ultrasound Physician	ME47793	FL
5	2085R0202X	Diagnostic Radiology Physician	ME47793	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	E7031A	OTHER	FL	MEDICARE-IDTF

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Z314	OTHER	FL	HEALTHEASE MED 3000
3	Z314	OTHER	FL	VISTA 26 MED 3000
4	Z314	OTHER	FL	WELLCARE HMO MED 3000
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043264419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN J SUKSTORF MD

Provider Business Mailing Address
First Line	:	602 HARBOR BLVD
Second Line	:	UNIT 101
City	:	DESTIN
State	:	FL
Zip	:	32541-2480
Country	:	US
Telephone Number	:	850-974-1723
Fax Number	:	850-654-5059

Provider Business Practice Location Address
First Line	:	4511 N DAVIS HWY
Second Line	:	STE 1B
City	:	PENSACOLA
State	:	FL
Zip	:	32503-2720
Country	:	US
Telephone Number	:	850-484-8454
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	05/06/2021

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