Provider Demographics
NPI:1205356607
Name:SUAZO MARTINEZ, MIGUEL MILTON (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:MILTON
Last Name:SUAZO MARTINEZ
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 1:222 S WOODS MILL RD STE 760N
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3654
Mailing Address - Country:US
Mailing Address - Phone:314-205-6050
Mailing Address - Fax:314-434-5939
Practice Address - Street 1:222 S WOODS MILL RD STE 760N
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3654
Practice Address - Country:US
Practice Address - Phone:314-205-6050
Practice Address - Fax:314-434-5939
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017018236207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine