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NPI Code Detail

MEDICARE: SUMA P PETER MD

MEDICARE: SUMA P PETER 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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician036087465IL

General Provider Information

NPI Number : 1730199944
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUMA P PETER MD
Provider Business Mailing Address
First Line : 611 W PARK ST
Second Line : BWPC
City : URBANA
State : IL
Zip : 61801-2529
Country : US
Telephone Number : 217-383-6792
Fax Number : 217-326-1777
Provider Business Practice Location Address
First Line : 1818 E WINDSOR RD
Second Line :
City : URBANA
State : IL
Zip : 61802-9566
Country : US
Telephone Number : 217-255-9646
Fax Number : 217-326-1777
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 05/06/2015

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