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NPI Code Detail

MEDICARE: BRIAN SU MD

MEDICARE: BRIAN 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
1207RN0300XNephrology Physician317628NY
2207R00000XInternal Medicine Physician317628NY
3207R00000XInternal Medicine Physician01099129AIN

General Provider Information

NPI Number : 1205307154
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN SU MD
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11109 PARKVIEW PLAZA DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number : 260-672-6620
Fax Number : 260-672-6639
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2018
Last Update Date : 03/09/2026

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Directions to “ BRIAN SU MD” Practice Location

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