Provider Demographics
NPI:1073501789
Name:ANNONI-SUAU, LUIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:R
Last Name:ANNONI-SUAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 LITTLE ROAD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-862-3202
Mailing Address - Fax:727-862-2182
Practice Address - Street 1:14100 FIVAY RD
Practice Address - Street 2:SUITE 310
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-862-3202
Practice Address - Fax:727-862-2182
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68092207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2505231OtherUNITED HEALTH CARE
FL378583100Medicaid
0656257OtherAETNA
214667OtherAVMED
6384447002OtherCIGNA
27056OtherBLUE CROSS BLUE SHIELD
FL378583100Medicaid
0656257OtherAETNA