Organization
SUKSANONG AND SUKSANONG MDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINGQUAN SUKSANONG MD (VP)
(727) 823-7224
Entity
Organization
Contact information
Practice address
1752 MLK JR ST N, ST PETERSBURG, FL 33704-4206
(727) 823-7224
(727) 489-9486
Mailing address
PO BOX 1945, PALM HARBOR, FL 34682-1945
(727) 771-1300
(727) 781-2300
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
ME31666
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DQ8992
RR MEDICARE
FL
Enumeration date
11/16/2007
Last updated
05/01/2012
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