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Individual
MRS. KAE M SUKUT
Active
Individual
MRS. KAE M SUKUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
427
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578518916
—
MT
01
—
97363
BLUE CROSS/BLUE SHIELD
MT
01
—
DG9848
MEDICARE RAILROAD GROUP NUMBER
—
01
—
POO475855
MEDICARE RAILROAD PTAN
—
Enumeration date
05/24/2006
Last updated
02/03/2021
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