Provider Demographics
NPI:1245384106
Name:SUSKO, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:SUSKO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2021 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2208
Mailing Address - Country:US
Mailing Address - Phone:310-829-5557
Mailing Address - Fax:310-829-5554
Practice Address - Street 1:2021 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 200E
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2208
Practice Address - Country:US
Practice Address - Phone:310-829-5557
Practice Address - Fax:310-829-5554
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2017-02-21
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Provider Licenses
StateLicense IDTaxonomies
CAA48150207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF58510Medicare UPIN