Individual
AMBROSE K SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
DP00159
OR
213E00000X
Podiatrist
DPOO159
OR
213ES0000X
Sports Medicine Podiatrist
DP00159
OR
213ES0103X
Foot & Ankle Surgery Podiatrist
DP00159
OR
213ES0131X
Foot Surgery Podiatrist
Primary
DP00159
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024734001
BLUE CROSS
OR
01
—
13578
CLEAR CHOICE HEALTH PLANS
OR
05
—
214619
—
OR
01
—
480031260
RR MEDICARE
OR
Enumeration date
12/14/2005
Last updated
01/16/2013
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