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NPI Code Detail

MEDICARE: AMY SUTKUS M.D.

MEDICARE: AMY SUTKUS 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
1207Q00000XFamily Medicine PhysicianMD29295OR

General Provider Information

NPI Number : 1588869119
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY SUTKUS M.D.
Provider Business Mailing Address
First Line : PO BOX 47
Second Line :
City : MILL CITY
State : OR
Zip : 97360-0047
Country : US
Telephone Number : 503-897-4100
Fax Number : 503-897-2673
Provider Business Practice Location Address
First Line : 280 S 1ST AVE
Second Line :
City : MILL CITY
State : OR
Zip : 97360-2324
Country : US
Telephone Number : 503-897-4100
Fax Number : 503-897-2673
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2007
Last Update Date : 02/01/2022

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