Provider Demographics
NPI:1164436523
Name:SUH, RONALD S (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:S
Last Name:SUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1262
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:120 AVON MARKETPLACE STE 200
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6021
Practice Address - Country:US
Practice Address - Phone:317-890-2000
Practice Address - Fax:317-671-8033
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060497A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194370OtherMEDICAID GROUP NUMBER
IN200288740OtherMEDICAID GROUP NUMBER
IN1487680518OtherGROUP NPI
IN000000366998OtherANTHEM PIN NUMBER
INP00260933OtherMEDICARE RAILROAD
IN200523730Medicaid
IN100194370OtherMEDICAID GROUP NUMBER
IN896480YMedicare PIN
IN200288740OtherMEDICAID GROUP NUMBER
IN345000WMedicare PIN