Provider Demographics
NPI:1346287364
Name:SUH, ELSA J (MD)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:J
Last Name:SUH
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3003 W DR MLK JR BLVD
Mailing Address - Street 2:3RD FLOOR MAB MS# 3043
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:727-322-4830
Mailing Address - Fax:813-870-0100
Practice Address - Street 1:3003 W DR MLK JR BLVD
Practice Address - Street 2:3RD FLOOR MAB MS# 3043
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:727-322-4830
Practice Address - Fax:813-870-0100
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL710312080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252943200Medicaid
FL41323ZMedicare ID - Type Unspecified
FL252943200Medicaid