Provider Demographics
NPI:1245220953
Name:CUTLIFF, SUE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:ANN
Last Name:CUTLIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2952
Mailing Address - Country:US
Mailing Address - Phone:502-499-8208
Mailing Address - Fax:502-499-8209
Practice Address - Street 1:2707 TUCKER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2952
Practice Address - Country:US
Practice Address - Phone:502-499-8208
Practice Address - Fax:502-499-8209
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000352718OtherANTHEM PIN #