Individual
KIMBERLY GANSTER SUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1575
Mailing address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD444386
PA
207R00000X
Internal Medicine Physician
MT194745
PA
390200000X
Student in an Organized Health Care Education/Training Program
MT194745
PA
Other
Enumeration date
04/24/2009
Last updated
10/15/2015
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