MEDICARE: SUTTER MEDICAL GROUP OF THE REDWOODS

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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1144479841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUTTER MEDICAL GROUP OF THE REDWOODS

Provider Business Mailing Address
First Line	:	3883 AIRWAY DR
Second Line	:	SUITE 300
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1670
Country	:	US
Telephone Number	:	707-521-8809
Fax Number	:	707-521-8835

Provider Business Practice Location Address
First Line	:	451 MARCH AVE STE B
Second Line	:
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3387
Country	:	US
Telephone Number	:	707-433-8844
Fax Number	:	707-433-8836

Authorized Official
Title or Position	:	PRESIDENT, SMGR
Name	:	DR. STEVEN E LEVENBERG
Credential	:	D.O.
Telephone Number	:	707-521-8879

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	09/17/2008

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