Provider Demographics
NPI:1326092453
Name:SUKSTORF, ANGELA C (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
Last Name:SUKSTORF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:C
Other - Last Name:REMINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2540 N HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2315
Mailing Address - Country:US
Mailing Address - Phone:402-727-1091
Mailing Address - Fax:402-727-7628
Practice Address - Street 1:450 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2303
Practice Address - Country:US
Practice Address - Phone:402-941-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22674207RI0200X
IA37639207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47071720712Medicaid
NE097664003Medicare PIN
NEI50610Medicare UPIN
NE47081309213Medicaid
NEP00315217Medicare UPIN
IA0719864Medicaid
NE470813092OtherCHAMPUS
NE098798Medicare PIN