MEDICARE: GREGORY KENNETH SUELZLE 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	208VP0014X	Interventional Pain Medicine Physician	G77184	CA

General Provider Information

NPI Number	:	1326016023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY KENNETH SUELZLE MD

Provider Business Mailing Address
First Line	:	1330 SAN BERNARDINO RD
Second Line	:	SUITE B
City	:	UPLAND
State	:	CA
Zip	:	91786-4928
Country	:	US
Telephone Number	:	909-981-0608
Fax Number	:	909-982-5327

Provider Business Practice Location Address
First Line	:	1330 SAN BERNARDINO RD
Second Line	:	SUITE B
City	:	UPLAND
State	:	CA
Zip	:	91786-4928
Country	:	US
Telephone Number	:	909-981-0608
Fax Number	:	909-982-5327

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	09/20/2010

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