MEDICARE: DR. MICHAEL SUE 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	173000000X	Legal Medicine	9600169	NC
2	174400000X	Specialist	151718	NC
3	207R00000X	Internal Medicine Physician	0101048956	VA
4	207RG0100X	Gastroenterology Physician	0101048956	VA
5	207RG0100X	Gastroenterology Physician	C1-0012813	DE

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100008745	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	561976984	OTHER	NC	TAX-ID
3	2954451	OTHER	NC	UNITED HEALTHCARE
4	559662	OTHER	NC	ALLIANE PPO
5	80781	OTHER	NC	BCBS OF NORTH CAROLINA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548245806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SUE M.D.

Provider Business Mailing Address
First Line	:	102 NORTHSIDE PARK
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9337
Country	:	US
Telephone Number	:	252-335-4619
Fax Number	:	252-335-5744

Provider Business Practice Location Address
First Line	:	102 NORTHSIDE PARK
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9337
Country	:	US
Telephone Number	:	252-335-4619
Fax Number	:	252-335-5744

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	01/11/2023

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