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Individual

DR. THOMAS LYNN SUTULA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
714 N MICHIGAN ST, SOUTH BEND, IN 46601-1035
(574) 647-7477
(574) 647-3655
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036117A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000085135
ANTHEM
IN
01
000000488324
ANTHEM
IN
01
000000681919
ANTHEM
IN
01
080191116
RR MEDICARE
IN
05
100336100
IN
Enumeration date
12/01/2005
Last updated
04/05/2021
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