MEDICARE: THERESA SUOZZI 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	207Q00000X	Family Medicine Physician	048872	CT
2	207Q00000X	Family Medicine Physician	45999	CO
3	207QA0401X	Addiction Medicine (Family Medicine) Physician	01072785A	IN
4	207Q00000X	Family Medicine Physician	01072785A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01347744	OTHER	IN	RAILROAD MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952544199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA SUOZZI MD

Provider Business Mailing Address
First Line	:	6626 E. 75TH STREET
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 N SHADELAND AVE STE 250
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1712
Country	:	US
Telephone Number	:	317-355-5009
Fax Number	:

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

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	11/27/2023

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Directions to “ THERESA SUOZZI MD” Practice Location

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