MEDICARE: SUE-MI C TUTTLE M.D.

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	208200000X	Plastic Surgery Physician	51814	MN
2	2086S0122X	Plastic and Reconstructive Surgery Physician	51814	MN

General Provider Information

NPI Number	:	1447442702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE-MI C TUTTLE M.D.

Provider Business Mailing Address
First Line	:	7450 FRANCE AVE S STE 220
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4792
Country	:	US
Telephone Number	:	952-925-1111
Fax Number	:	952-922-3446

Provider Business Practice Location Address
First Line	:	7450 FRANCE AVE S STE 220
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-4792
Country	:	US
Telephone Number	:	952-925-1111
Fax Number	:	952-922-3446

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	12/12/2023

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