MEDICARE: DR. SUZANNE YVETTE SUCCOP 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	207RI0200X	Infectious Disease Physician	ME62069	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578583076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE YVETTE SUCCOP M.D.

Provider Business Mailing Address
First Line	:	3245 EQUESTRIAN DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33434-3361
Country	:	US
Telephone Number	:	561-738-7007
Fax Number	:	561-738-7421

Provider Business Practice Location Address
First Line	:	200 KNUTH RD
Second Line	:	SUITE 150
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4629
Country	:	US
Telephone Number	:	561-738-7007
Fax Number	:	561-738-7421

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	11/27/2013

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