Individual
KEITH S. SUSKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4977 ROYAL GULF CIR, FORT MYERS, FL 33966-7006
(239) 226-0077
(239) 489-0077
Mailing address
PO BOX 222, ESTERO, FL 33929-0222
(239) 226-0077
(239) 489-0077
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME85368
FL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
ME85368
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17033
BCBS
FL
01
—
17033X
MEDICARE
FL
05
—
2658666-00
—
FL
Enumeration date
04/05/2006
Last updated
09/26/2023
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