Provider Demographics
NPI:1194839647
Name:SUCHECKI, SLADE ALAN (DO)
Entity Type:Individual
Prefix:DR
First Name:SLADE
Middle Name:ALAN
Last Name:SUCHECKI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3960 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-8184
Mailing Address - Country:US
Mailing Address - Phone:910-454-4343
Mailing Address - Fax:910-457-9209
Practice Address - Street 1:3960 EXECUTIVE PARK BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-8184
Practice Address - Country:US
Practice Address - Phone:910-454-4343
Practice Address - Fax:910-457-9209
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2010-02-08
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Provider Licenses
StateLicense IDTaxonomies
NC200401133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine