Provider Demographics
NPI:1003992546
Name:SUESS, STEVEN H
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:H
Last Name:SUESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15155
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61132-5155
Mailing Address - Country:US
Mailing Address - Phone:815-713-2627
Mailing Address - Fax:815-654-8020
Practice Address - Street 1:964 LOCHEND DR
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-5698
Practice Address - Country:US
Practice Address - Phone:843-777-6890
Practice Address - Fax:843-777-6891
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12712207Q00000X
OH35050485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC062OtherBCBS
SC20078182OtherSELECT HEALTH
SC4106556OtherAETNA
SC127124Medicaid
SC063OtherBCBS
SC210051OtherMEDCOST
SCAA28198552OtherMEDICARE PTAN
SC18500OtherEVOLUTIONS
NC5908977Medicaid
SC9292643OtherCIGNA
SC063OtherBLUECHOICE