MEDICARE: BRIAN SUTTERER 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	208100000X	Physical Medicine & Rehabilitation Physician	64254	MN
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	64254	MN

General Provider Information

NPI Number	:	1720519184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN SUTTERER MD

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 S MOUNT AUBURN RD STE 101
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4940
Country	:	US
Telephone Number	:	573-519-4960
Fax Number	:	573-519-4655

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

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	03/17/2026

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Directions to “ BRIAN SUTTERER MD” Practice Location

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