MEDICARE: THOMAS Y SU 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	207R00000X	Internal Medicine Physician	ME72741	FL

General Provider Information

NPI Number	:	1194050484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS Y SU MD

Provider Business Mailing Address
First Line	:	6319 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4537
Country	:	US
Telephone Number	:	813-886-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	6319 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-4537
Country	:	US
Telephone Number	:	813-886-9090
Fax Number	:

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

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	12/17/2019

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